Objective To observe the effects of limited fluid resuscitation (LFR) on immune function and inflammatory mediators in patients with multiple bone fracturescomplicated with traumatic hemorrhagic shock. Methods One hundred and two patients with multiple bone fractures complicated with traumatic hemorrhagic shock admitted to the Affiliated Hospital of Medical College of Ningbo University from January 2014 to June 2016 were enrolled, and they were divided into a LFR group and a early sufficient routine fluid resuscitation (RFR) group by random number table, each group 51 cases. After admission, the patients in the two groups underwent bandaging and hemostasis at the traumatic sites and preoperative management was prepared. The patients in RFR group were treated with early sufficient RFR, while LFR group was treated with LFR. The changes of hematocrit (HCT), blood platelet count (PLT), prothrombin time (PT), blood lactic acid and immune cells, inflammatory mediators and micro RNA-155 (miR-155) were observed in patients of the two groups at 4 hours after resuscitation.Results Compared with RFR group, the resuscitation time (hours: 3.67±1.45 vs. 5.14±1.61), levels of PT (s: 11.43±2.21 vs. 15.73±2.52), serum lactic acid (mmol/L: 3.35±0.15 vs. 3.81±0.25), tumour necrosis factor-α [TNF-α (ng/L): 14.10±3.39 vs. 16.28±3.47], interleukin [IL-10 (ng/L): 31.43±10.51 vs. 40.09±13.23, IL-6 (ng/L): 490.10±55.13 vs. 610.30±63.15] and endothelin-1 [ET-1 (pg/L): 183.35±30.51 vs. 250.01±31.23] in LFR group were significantly decreased (allP < 0.01), while PLT (×109/L: 134.58±28.13 vs. 108.12±30.35), HCT (×10-2: 0.34±0.04 vs. 0.24±0.05), miR-155 (0.15±0.02 vs. 0.08±0.02) and CD4+CD25+ regulatory T cell [CD4+CD25+Treg (×10-2): 2.28±0.47 vs. 2.10±0.39] in LFR group were obviously increased (allP < 0.01).Conclusions Using LFR in the emergency treatment of patients with multiple bone fractures complicated with traumatic hemorrhagic shock can effectively shorten the resuscitation time, regulate the patients' coagulation function, reduce the unnecessary excessive liquid infusion, improve immune status and decrease the degree of inflammatory reaction.

Objective To investigate the effect of retrograde sartorius myocutaneous flap for reparing skin defects of leg.Methods In the anatomic study,50 cadaveric lower limb were injected with red latex and the origin,diameter,course,distribution and anastomosis of sartorius's arteries were observed.Arteriographies were made in 4 sides of fresh specimens to study the arterial anastomosis in sartorius.Based on anatomic research results,we designed the retrograde sartorius myocutaneous flap for reparing skin defects of leg.Results Nutrient arteries of sartorius represented segnental distribution,Link-pattern arterial anastomosises were formed in sartorius by branches of adjacent vascular pedicles.Cutaneous arteries and musculocutaneous arteries above deep fascia formed interlocking arterial anastomosises net which provided blood supply for the skin on sartorius.The arterial branches in the distal 2/5 of sartorius came from saphenous artery,composed an arterial network around knee joint,which consist of anatomic basis for the blood supply of retrograde sartorius myocutaneous flap.Form February,2010 to April,2014,the retrograde sartorius myocutaneous flap were used to repair skin defects of leg in 2 cases.The flap size ranged from 7 cn×18 cm to 12 cm×25 cm.All flaps survived successfully with no ulcer.2 cases were followed up for 7 to 16 months.The skin color and texture were satisfactory.Conclusion the retrograde sartorius myocutaneous flap has constantly,reliable blood supply,and easily performed.It is an effective method for the reconstruction skin defects of leg.

Objective To investigate the effect of iliac flap pedicled with superficial circumflex iliac artery and sartorius in the treatment of femoral neck fracture of the young adults.Methods From April,2012 to March,2017,50 cadaveric lower limbs were injected with red latex,and the origin,diameter,course and distribution of the superficial circumflex iliac artery and arteries of the sartorius were observed.The iliac flap pedicled with superficial circumflex iliac artery and sartorius was used to treat the femoral neck fracture in young adults in 11 cases.There were 9 males and 2 females with an average age of 34.5(ranged from 16 to 54) years.The fractures were classified ac cording to Garden:4 cases of type Ⅲ and 7 cases of type Ⅳ.Regular outpatient follow-up was made.Results The superficial circumflex iliac artery originated from the femoral artery and the initial diameter was (1.2±0.3) mm.The length of the superficial circumflex iliac artery to the anterior superior iliac spine was (8.8±1.3) cm.The superficial circumflex iliac artery run to the anterior superior iliac spine and sent 1-3 periosteal branches into the iliac crest.The sartorius originates from the anterior superior iliac spine,and its proximal artery arises from the superficial circumflex iliac artery and the femoral artery.Link-pattern arterial anastomosises were formed in sartorius by branches of adja cent vascular pedicles,which nourished the ilium flap.All incisions healed by first intention.All cases were followedup from 16 to 42 months,with an average of 32.3 months.All fractures healed for 3-7 months,with an average of 4.6 months.No fracture nonunion,femoral head necrosis and other complications occurred.Harris hip scores was 93.02± 5.33.Seven cases were excellent and 4 cases were good.Conclusion The iliac flap pedicled with superficial cir cumflex iliac artery and sartorius has rich blood supply,easily performed conducive to promoting fracture healing,and reducing the occurrence of femoral head necrosis.It is an effective method for the treatment of femoral neck fracture in young adults.