Objective The severe hypospadias is present with complicated deformity,and the successful rate of treatment is low with high complication rate.Here is to present a kind of useful and reliable treatment for it.Methods From 2004 to 2005,the scrotal septal island skin flap combined with the scrotal split thickness skin graft to form the neourethra in a stage was used to treat the hypospadias without underdeveloped scrotum.Results A total of 15 patients including proximal penile,penioscrotum and scrotal hypospadias who were followed up for about 1 year healed well without the occurrence of urethral stricture and urethral fistula,the penile curvature was corrected and the urine line was direct,and the endoscopic examination showed the inner wall of the urethra was smooth and intact.Conclusions The application of the scrotum septum flap combined with the scrotal splitted thickness skin graft to form the neourethra in one stage is reliable to treat the severe hypospadias with the simple procedure.The combined technique has obtained both the advantages of the skin graft and the skin flap to form the neourethra,and it could be used to correct the curvature of the penile.Thus the satisfactory result of the appearance and the function could be achieved.The technique is an excellent procedure.

Objective To reconstruct the soft tissue defect in the back or neck after excision of hypertrophoc scar or giant nevus by using transmidline pre expanding scapula flap vascularied by ipsilateral circumflex scapular artery. Methods The reconstruction can be accomplished in two stage procedures. First, scapular flaps were expanded for 4 6 weeks prior to transfer in 8 patients. Second,the pedicled flaps were designed across the entire back to incorporate both scapular territories but were rotated on a single vascular pedicle. Results All flaps survived. Only two flaps had marginal necrosis, and the wound healed well by dressing. Conclusion Flap expansion produces a delay that augments blood supply and increases the area of skin that survives on a single vascular pedicle. This technique may be useful in selected patients in whom a large and thin fasciocutaneous flap is required and there is sufficient time to allow flap expansion prior to thansfer. It is easy to harvest, and donor site morbidity is negligible. The patients can get better functions and quality of life.

Objective To study urethral epithelium cu lt ure in vitro as a basic role in the further study on tissue engineering urethra. Methods A bit of urethral mucosa was taken from a young male New Zealand hare and was digested by enzyme into single cell liquid.The ce ll was then cultured in a still condition.The medium was renewed regularly and t he cells were subcultured and studied. Results All the c utured cells were urethral diploid cells without fibroblasts.The cells could be subcultured 11～13 generations with a surviving period of 50～60 days. Conclusions The urethral epithelium the cultured cells of young N ew Zealand hare can be cultured in vitro and is able to proliferate within a cer tain period.This provides a strong foundation for the further study on tissue en gineering urethra.

Objective To carried out rat as deep inferior epigastic perforator (DIEP) flap necrosis model,to reveal the continuous blood fluid change in process of flap necrosis.Methods Seven SpragueDawley rats of male were used.The designed DIEP flap model was pedicled on the right-sided cranial perforator.Near-infrared fluorescent angiography was performed using SPY imaging system pre-and-aft operation and all angiography videos were compared and analyzed.Results Using SPY imaging system could observe the process of the blood fluid scattered from perforator through choke anastomoses to next vascular territories in living body.The study could clearly observe sequence change of blood fluid pr-and-aft operation,which could give the important information in revealing the reason of necrosis in DIEP flap.Cross-midline traffic vascular sparse and eventually could no longer wear through the contralateral abdominal wall vessel area and open in the region of lateral thoracic vascular occlusion of blood vessels to reach the flap to the far left side,and showed no blood flow in the dark zone.Conclusion The reasons of necrosis of contralateral distal zone of the flap model,are the choke anastomoses across the midline to the contralateral side appeared small,less intensity and the blood supply to contralatral distal zone should through twice choke anastomoses.

ObjectiveTo study the expressions of Ki-67 and p53 in the surface cells and polygonal cells in pulmonary sclerosing hemangioma(PSH)and investigate the relation of cell proliferation index and biological behaviour of the tumor.MethodsDouble-staining immunohistochemistry was used to detect the expressions of Ki-67 and CK8/18 protein. Double immunofluorescence staining was used to detect the expressions of p53 and AE1/AE3 protein. ResultsThe positive signal of AE1/AE3 and CK8/18 were localized in cytomembrane of surface cells. The positive signal of Ki-67 and p53 were localized in cell nucleus of the two kinds of cells.The positive rate of Ki-67 was under 1％ in surface cells and 1％-10 ％ in polygonal cells. p53 protein was mainly expressed in polygonal cells (6/9, 33.3 ％) and only exsited in seldom surface cells.ConclusionThere are differences on cellular morphous and immunophenotype between the surface cells and polygonal cells.The proliferation index and gene mutation are all predominant in polygonal cells than in surface cells. The biological behaviour of PSH maybe mainly be decided by the polygonal cells.

Objective To study the changes of muscle being injected with botulinum toxin A in different period of time,helping for chemically denervated muscle transplantation.Methods Sixteen rabbits were divided into 4 groups.The extensor carpi radialis muscle in one side was chosen for experimental group with the opposite muscle for control group.Morphological changes,histological changes and electron microscopic changes of muscle being injected with botulinum toxin A were observed from the first week to the fouth week.Results The quantity of glycogen and mitochondria in the muscles reduced in the first week.But it was obvious in the third week.We also found some necrotic areas in the fouth week with the muscles restoring.Conclusions The effect of metabolism slowing down and the volume of muscle reducing after botulinum toxin A injection is obvious in third weeks.It could help us choose the best time of chemically denervated muscle transplantation.

OBJECTIVETo introduce the application of pedicled anterolateral thigh (ALT) flap for total penile reconstruction and to investigate its feasibility and effect.

METHODSFrom May 2011 to May 2015, 12 male patients presented with absence of the penis or congenital malformation received phalloplasty with the pedicled ALT flap. Of them, the median age was 35 years old (range, 20-57 years). The size of the flaps ranged from 11 cm x 11 cm to 12 cm x 15 cm. 8 patients underwent urethra reconstruction with tube-in-tube flaps and other 4 patients with scrotal septal flaps. In this series, we performed one-stage urethral anastomosis in 4 cases and second-stage urethral anastomosis 6 months after the phalloplasty in 8 cases.

RESULTSAn acceptable reconstructed phallus was achieved in 10 patients. These flaps were primarily healed with satisfactory functional and cosmetic results. The reconstructed penis was completely necrosis because of the flap failure in one case. The distal half of the phallus was lost due to infection in one case. Both of them were treated with pedicled ALT flap from the other side. Reliable results were achieved. At a median follow-up of 1.5 year (range 1 to 4 years), 9 patients (90%) were fully satisfied with phallic cosmesis and size, and 4 patients who was married had successful sexual intercourse. 8 patients had normal urinate function. Fistula was developed in 2 patients (20%) which was treated with delayed repair at 6-12 months with local scrotal flaps.

CONCLUSIONSThe pedicled ALT flap can be simply used to reconstruct an entire penis as well as a urethra. It has several advantages including a less conspicuous donor site, greater bulk, better color match and no necessary for microsurgery.

Adult ; Anastomosis, Surgical ; methods ; Coitus ; Feasibility Studies ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Necrosis ; etiology ; Penis ; abnormalities ; surgery ; Reconstructive Surgical Procedures ; methods ; Scrotum ; Surgical Flaps ; pathology ; transplantation ; Thigh ; Time Factors ; Urethra ; surgery ; Young Adult

Objective To investigate a new method and to observe the clinical effect of repairing the lower eyelid ectropion assisted with the subcutaneous pedicle flap from temporal region. Methods Since 2007, 24 patients with lower eyelid ectropion were treated with the subcutaneous pedicle flap from temporal region which was the donor area without hairs, including 8 cases of scar infection, 6 cases of trauma, and 10 cases of tumor removal. Among the 24 cases of the flap, the maximum area was 5. 5 cm× 1. 5 cm,and the minimum was 4. 0 cm × 1.0 cm. Results All patients were followed up for 6 months to 3 years.All flaps survived completely with excellent texture and appearance. The donor site was hidden and no obvious malformation of the donor site was observed. Conclusions Because the blood supply of flap is reliable and the incision in the donor site is hidden, the subcutaneous pedicle flap from temporal region pedicled with arterial network of the outer canthus is an ideal donor site for repairing the lower eyelid ectropion with full thickness defects.

To summarize the development of perineal reconstructive surgeries and hypospadias repair. Based on years of clinical experience and literatures in plastics, the author introduced the methods and standards of congenital hypospadias and perineal deformities treatment after trauma or burn. In accordance with surgical techniques and principles, perineal deformities and hypospadias were well repaired applying tissue transplantation. In consideration of all kinds of infective factors and individual treatment, perineal deformities could be repaired both functionally and esthetically, and the hypospadias could be completely " cured" .

Objective To investigate the blood supply of the expanded skin flap from medial up-per arm and its application in the reparation of cervical scar contracture due to sear resection. Methods The operation was carried out for three steps: (1) The expander was implanted under the superficial fascia. (2) The skin flap from medial upper arm was created with superior ulnar collateral artery as blood supply and attributive branches of basilica and axillary veins as blood collection. (3) After thes car contracture was released, the defect was covered with medial upper arm flap with maximal area of 25 cm×15 cm. Results Ten patients in all with cervical scar contracture were treated with the skin flap. All the skin flaps survived at last with nearly normal skin color, texture and contour. And the scar in donor sites seemed to be neglectable. Conclusions Reparation of cervical scar contracture with medial upper arm skin flap after expanding could be recommended. But 3 months long time and fixation of upper limb and head might be disadvantages.