Objective To report the anatomy and clinical application of the marginal mandibular flap pedicled with facial artery in nose reconstruction. Methods Based on the anatomical study of facial artery, the reversed marginal mandibular island flap pedicled with facial artery was designed, and the nasal reconstruction with the flap was operated in 20 cases. Results In 20 cases, the maximal size of flap was 7.0 cm?6.5 cm, and the minimal size was 6.0 cm?4.5 cm, and except the distal part necrosis in one flap, and wound dehiscence in nasal collumella in another flap, all other flaps survived. Followed up for 3 months to 2 years, all reconstructed noses showed satisfactory shapes. Conclusion The method is a new design technique for nose reconstruction with ideal nose appearance, and worth to be recommended.

Objective To introduce a method of repairing the secondary vermilion defect caused by bilateral cleft lip. Methods The two side vermilion flaps beside the defect were cut along the vermilion boundary, and the lip artery was involved in the flaps. The flap may be extended to lower lip if the defect was much large. Then the two flaps were propelled to repair the defective region. Results This method was used in 15 cases, in which the biggest width of the defect was 1.2 cm, and the smallest was 1.0 cm, with all the flaps survived. The postoperative appearance of the upper lip was satisfactory. Conclusion The lip artery is constant, so the blood supply of the flap is reliable and anatomizing the flap is easy. This is a new method and can be widely used in repairing vermilion defects.

Objective To introduce the clinical application of the expanded scalp flap in the repair of baldness. Methods Based on area and shape of the baldness, two or three expanders were buried under the normal scalp galea around baldness. The scalp was expanded by intermittence injecting 0.9 % sodium chloride solution into expanders for 3 7 weeks, and then the expanded scalp flaps were used for repair of the baldness. Results Thirty expanders were used in twenty cases of patients with baldness, and all cases were satisfactory except two cases, in which the expanders exposed. Conclusion The treatment on baldness with expanded scalp flap is reliable. The donor site does not need graft skin. The scalp expansion may be the first choice in the repair of baldness.

Objective To investigate the method of repairing moderate or severe full defect of eyelid. Methods According to eyelid structure and the defect size, the two composite eyelid flaps were designed beside defect based on the arterial arch of the palpebral margins. If the defective area was too large, the lateral composite flap may be extended to lower or upper eyelid at the outer canthus, then the two flaps were propelled to the defective region to repair it. Results Eleven patients had been cured with this method since 1998. The largest length of eyelid defect was 1.7cm, and the smallest was 0.8cm. All defects exceeded 1/3 length of the upper or lower eyelid. All composite flaps survived completely without any complication. The appearance of the repaired eyelid was satisfactory. Conclusion Using the composite flap to repair the full moderate or severe full defect of eyelid is a new and effective method. It can not only provide enough tissues to repair large full defect of the upper or lower eyelid and to restore normal anatomical structure and appearance of the eyelid, but also is easy to be operated without severe secondary deformities, and the blood supply of the composite flap is reliable. The method is worth employing routinely.

Objective To introduce the anatomic basis and evaluat ion of clinical application of the pudendal-thigh island flaps us ing for vaginal reconstruction. Methods The blood supply and innervation to the skin and fascia of the pudendal-thigh region were studied in 5 female cadavers (with 10 sides). 20 patients who underwent vaginal reconstruction with pudendal-thigh island flaps were followed-up, and all the women were married for more than 3 years. Results There were multiple blood supply in the pudendal-thigh area. The cuta neous arterial vessels come from the posterior labial artery, the external pudendal artery and the anterior cutaneous branches of obturator artery. The posterior labial artery was one of the internal pudendal artery branches, a nd the diameter of it was 0.9～1.7 mm (1.3mm in average) in its original site, w hich was 22～35 mm (26mm in average) from the perineal midline. It gave off 4 ～7 branches to the major labia and the pudendal-thigh area while running alon g the lateral site of the major labia accompanying vein and nerve. 20 patients w ho were followed-up satisfied with their perineal appearance and with 10. 2 cm depth of neovagina in average. Twenty neovagina remained supple, and sexually active without difficulty. Conclusions The pedicle of the pudendal-thigh island flaps using for vaginal reconstruction is the post erior labial neurovascular bundle. The flap has reliable blood supply, survive s easily, transfers with partial sensation and few complications. This tech nique introduces a modified approch of vaginal reconstruction using bilateral pudendal- thigh island flaps with satisfactory cosmetic and functional resu lts.

Objective To explore the anatomical basis for clinical application of the compound flap pedicled with arterial arch of palpebral margin by observing eyelid blood supply and anatomical structure and to prove that it is an ideal method of repairing the eyelid defect for clinical application. Methods 15 adult cadavers (30 eyelids) were dissected. The origin, course, branches, diameters and vessel networks of palpebral margin arterial arch were observed particularly. 30 cases of eyelid marginal defect were reviewed and the therapeutic effect of this method evaluated. Results Eyelid was constituted by 5 layers: skin, subcutaneous tissue, muscle, tarsal plate and conjunctival layers. Most eyelid vessels were mutually anastomosed to form a constant vessel network. Palpebral margin arterial arch and peripheral arterial arch were formed by dorsal nasal artery branches and lacrimal artery branches, both of which nourished the eyelid tissue. All the compound flaps of 30 cases survived completely without any complications. All cases obtained satisfactory results functionally and esthetically. Conclusions The arterial arch of palpebral margin is constant and the blood supply of the compound flap is reliable. It can repair full eyelid defect with the same kind of tissue, and obtain satisfactory appearance. It is an ideal method of repairing the eyelid defect.

Objective To explore the efficacy of sulfasalazine for treatment for epilepsy induced by gliomas .Methods The patients with epilepsy caused by gliomas in neurosurgery department were recruited from March 2006 to December 2013 .Epilepsy was controlled with sulfasalazine .The efficacy of sulfasalazine for treatment for epilepsy induced by glioma were analyzed to calcu-late the 50% response rate ,75% response rate and seizure-free rate .Meanwhile the outcomes scores of therapy of sulfasalazine for varieties types of epilepsy were evaluated ,according to the end result of scoring criteria in epileptic seizures .Results A total of 31 patients were controlled with sulfasalazine .The average reduction rate of seizure frequency per month was 54 .32% ,61 .71% , 75 .74% after three months of treatment .The differences of average reduction rate of seizure frequency before and after the treat -ment have an evident statistic significance (P< 0 .01) .The 50% response rate ,75% response rate and seizure-free rate per month af-ter treatment with sulfasalazine have significant higher than those before treatment (F= 20 .007 ,P< 0 .01) .After 3 month of thera-py ,four different types of epilepsy was 100 .00% ,100 .00% ,84 .62% and 75 .00% in improvement rate added complete control rate .Those have no statistical difference(P> 0 .05) .Conclusion Sulfasalazine can effectively control seizures ,and both effective va-rious types of epileptic .

Objective To discuss the diagnosis and surgical management of multilocular cystic renal cell carcinoma (MCRCC) and to evaluate the gene function of the mutation of von Hippel-Lindau (VHL) gene in MCRCC. Methods Seventeen MCRCC cases (11 men and 6 women) out of 512 cases of renal cell carcinoma from 2000 to 2010 were retrospectively analyzed. The mean age of the 17 patients was 46 years (37-61 years). Ultrasonography and CT were available in all 17 cases, and 1 case was misdiagnosed as parapelvic renal cyst. The mutation of VHL gene was detected by PCR in the specimens of can-cerous tissue and adjacent normal tissue from 11 cases of MCRCC. Results Three of 17 cases underwent nephron sparing surgery, the others underwent radical nephrectomy. One case underwent unroofing of parapelvic renal cyst, but the rapid frozen pathology of the cyst wall showed renal cell carcinoma of clear type. As a result, radical nephrectomy was eventually performed. All 17 cases were confirmed as MCRCC by eva-luating pathological characteristics, such as the cyst wall lined by single or several layers of clear tumor cells and the nuclei which were small and anachromasis. Clinical stages of all cases were T1N0M0, in which there were 14 cases with pathological T1G1 and 3 cases with pathological T1G2. All patients underwent a follow-up of 9 to 36 months (mean, 12 months) without recurrence or metastasis. Mutation of VHL gene was detected in 7 of 11 cases (64%), but all adjacent normal tissues were negative. Conclusions As a rare subtype of renal cell carcinoma, MCRCC is difficult to diagnose. CT is an essential measure in diagnosis of MCRCC preoperatively. Because of the good prognosis of reported cases, nephron sparing surgery for the treatment of MCRCC is recommended. VHL gene mutations may play an important role in the carcinogenesis of MCRCC.

Objective To observe the significance of preoperative peripheral serum inflammatory cyto-kines and blood routine in predicting postoperative DVT in patients with neurosurgery.Methods A total of 156 pa-tients from the Department of Neurosurgery form April 2016 to April 2017 were recruited in this study.According to the incidence of postoperative deep venous thrombosis(DVT),patients were divided into DVT group(48 cases) and non-DVT group(108 cases). The date blood routine(including hematocrit,hemoglobin,neutrophil count, monocyte count,white blood cell count,platelet count)and serum inflammatory cytokines(including TNF-α,IL-1β,IL-1β,IL-6,IL-8)of two groups by t tests were compared.The possible risk factors for postoperative DVT in neurosurgical patients were analyzed by multivariate analysis logistic regression.The predicted cutoff value is deter-mined by plotting the subject's working characteristic(ROC)curve.Results Between the control group and DVT group,there were significant differences in preoperative blood neutrophil count,hemoglobin,TNF-α,IL-6 and IL-8(P < 0.05). Multivariate analysis logistic regression showed that the level of neutrophil count and concentration of serum TNF-α concentration were increased,indicating they may be the risk factors of DVT.For the neutrophilic granulocyte count,the value of specificity and sensibility was 82.7%and 61.7%respectively.For the TNF-α level, the value of specificity was 72.3% and the value of sensibility was 83.1%. Conclusion The level of preoperative neutrophil count and the concentration of TNF-α have value in predicting the occurrence of postoperative DVT in neurosurgical patients.

OBJECTIVETo introduce a method of repairing facial tissue defects caused by various factors.

METHODSThe reverse narrow pedicle lateral maxillocervical fasciocutaneous flap was designed with its pedicle located in front of auricle. The size of the flaps ranged from 5 cm x 6 cm to 10 cm x 11 cm. The length and width of the pedicle ranged 2 cm-5 cm and 1 cm-1.5 cm.

RESULTSThis fasciocutaneous flap was used in 21 cases. All flaps survived except 1 flap showing distal skin necrosis.

CONCLUSIONThis fasciocutaneous flap didn't include any major blood vessel. The ratio of the pedicle width to flap length broke that of traditional flap and was reverse transfer. The transposition of the narrow pedicle flap was easy. The postoperative appearance (color, texture, cosmetic aspect) was satisfactory. This method was a new design and was ideal for large facial tissue defect repair.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Face ; surgery ; Female ; Humans ; Infant ; Male ; Middle Aged ; Surgical Flaps