Objective To explore relationships between the aesthetical education and the development of students' entire quality in medical school. Methods Taking the Introduction to Medical Aesthetics as the blueprint, we used the multimedia during the whole courses while considering our student's actual needs. Students were given tests and a questionnaire. Results 114 students took the examination, 89.5 % of which achieved the "good" grade, while 10. 5 % of them got the "pass"grade; none of them failed to the test. Conclusion The aesthetical education has taken great impressions on the development of the students' aesthetical quality.

Objective:To introduce a new style of platysma myocutaneous flap and to evaluate its application value in the restoration of oral-maxiofacial defects.Methods:Platysma myocutaneous flap with apron incision was used for the restoration of oral-maxiofacial defects after oral lesion ablation in 15 cases from January,2014 to September,2015.The platysma muocutaneous flap was harvested with a U shaped apron incision.The skin above the flap pedicle was preserved.The platysma pedicle was widened to ensure the flap survival.All the patients were followed up form 4 to 33 months.Results:Of the 15 platysma myocutaneous flaps,12 survived completely and 3 had partial flap necrosis.The total survival rate of the flaps at the recipient site of buccal mucosa,tongue and alveolar was 8/9,1/3 and 3/3 respectively.Additionally,there were 2 cases of disturbed wound healing in the neck.Except for 1 case of carcinoma of gingiva which had apparent cervical scar and 1 case of tongue carcinoma which had limited tongue mobility,the other cases showed a satisfactory recovery of oral-maxillofacial contour and fucnction.Conclusion:Compared with the traditional platysma myocutaneous flap,the platysma myocutaneous flap with apron incision can provide a larger skin paddle,and is suitable for the restoration of small and medium sized buccal mucosa and alveloar defects,but not for tongue defect.

OBJECTIVETo evaluate the feasibility and outcomes of chimeric deep circumflex iliac artery perforator flap (DCIAPF) applied in the simultaneous reconstruction of the oromandibular defect.

METHODSSix patients underwent simultaneous oromandibular reconstruction using DCIAPF following segmental mandibulectomy in Xiangya Hospital from March 2014 to July 2014. The skin paddle was designed to be centered on the pre-operative perforator mapping. Retrograde dissection was performed through the underlying abdominal wall to raise the skin paddle. The pedicle was isolated from the groin, and the iliac crest was cut. The deep iliac circumflex vessels were dissected until the skin paddle was reached. Finally, the donor site was strictly sutured layer by layer to avoid ventral hernia.

RESULTSThe skin paddles ranged from 3.5 cmx5.0 cm to 7.0 cmx 10.0 cm. The length of the bone components was 5.0 cm to 11.0 cm. All donor sites closed primarily without skin grafting. DCIAPF was harvested successfully in five patients, except for one patient whose perforator originated from the superficial iliac circumflex vessels. An additional pair of anastomoses was performed. All iliac flaps survived. However, slight skin-edge necrosis and exfoliation caused by flap thinning occurred in one patient and healed after pruning and dressing change. The heights of all alveolar ridges were significantly restored, and no serious donorsite complication was observed during the three to six months' follow-up.

CONCLUSIONDCIAPF is a reconstructive option for mandibular defects because of its adequate bone tissue and rich blood supply. Satisfactory alveolar ridge restoration greatly facilitates future denture retention. DCIAPF also has a great degree of mobility between the skin paddle and the bone component when appliedin composite oromandibular defect reconstruction.

Humans ; Iliac Artery ; Ilium ; Mandible ; surgery ; Maxillofacial Abnormalities ; surgery ; Perforator Flap ; Reconstructive Surgical Procedures ; methods ; Skin

Objective To assess the harvest method and application value of free-style anterolateral thigh perforator flap (ALTPF) in oral-maxillofacial reconstruction.Methods Fifty-three patients who suffered from oral and maxillofacial tumor underwent simultaneous reconstruction using free-style ALTPFs after radical resection from August,2013 to May,2014.Perforators of the ALTPF region were marked through hand-held Doppler probe preoperatively.Flaps were designed centered on perforators according to the defect size of the accepting site.Incisions were first made at the inner border of the designed flap.Perforators were exposed above the fascia lata femoris and then dissected retrogradely through the vastus lateralis muscle to harvest a vascular pedicle with desired caliber and length.Flap thinning was applied under microscope in some cases to compromise the need of the accepting site.Results All 53 flaps survived after transplantation while skin exfoliation occurred in 5 cases due to flap thinning.Four cases sustained partial necrosis and was cured by trimming and dressing changes.Five to 14 months' post-operative followup showed satisfactory accepting-site morphology with good speech function and swallowing recovery.All donor sites were closed primarily without skin-grafting,leaving no donor-site complications including incision disruption,scar hyperplasia and muscle strength degeneration of the lower limb.Conclusion Multiple perforators have been accu rately located preoperatively in free-style harvest approach of ALTPFs,thus optimal effects can be reached with decreased donor-site morbidity and improved aesthetic outcome to the uttermost,which accords with the refined,personalized and minimal invasive development concept of modem reconstructive surgery.

BACKGROUND:Fast track surgery, also cal ed enhanced recovery after surgery, is a series of optimal measures adopted during the perioperative period on the basis of evidence-based medicine, to reduce the physical and mental trauma brought to the patient and accelerate their recovery. It has become the research focus of orthopedic clinic as the surgery and anesthesia skil s are improved a lot in recent years, especial y the articular surgery, which has been widely used in clinics. OBJECTIVE:To summarize the clinical study of the application of optimal measures in joint replacement surgery both at home and abroad in recent years. METHODS:The first author searched related articles in PubMed and Chinese Journal Ful-text Database from January 1997 to September 2016. The key words were“joint replacement, enhanced recovery after surgery, multi-mode analgesia, diet management, steroid hormones”. 81 articles were found at last and one monograph was included. RESULTS AND CONCLUSION:(1) We found that the recovery plan reduced the hospital stays of the patients from 4-12 days to 1-3 days, including pre-operative health education, shortening fasting and water-depriving duration before surgery, super-anesthesia before surgery and do not place catheter;adopting general anesthesia and appropriate adductor canal to relieve the pain, and stopping bleeding using tranexamic acid during operation;multi-mode analgesia, faster function exercise after anesthesia recovery, and drinking water in early phase after surgery during the perioperative period of joint replacement surgery conducted by the cooperation of surgeon, anesthetist, nurse and nutritionist. There were no significant improvements of postoperative complications rate and rehospitalization rate. (2) The research found that, enhanced recovery after surgery is suitable for most of the patients receiving joint replacement surgery, including those in advanced age, combined heart and lung disease before surgery, type 2 diabetes and smoking and drinking before surgery.

Objective To assess the clinical application value of phleboplasties combined with microvascular anastomotic device in venous anastomosis with diameter discrepancy in head and neck defects reconstruction.Methods Sixty-six pairs of veins with significant diameter discrepancy were anastomosed in head and neck reconstructive surgeries with free flaps.Forty of them were anastomosed with microvascular anastomotic device (the coupler group) after phleboplasties including lateral incision, Y-T enlargement and wedge excision while the other 26 pairs of veins were conventionally sutured (the sutured group).Diameter of each vein, anastomosis time, post-operative vascular crisis, flap survival and complications related to the microvascular anastomotic device were recorded.Results The average anastomosis time of the coupler group was (4.78 ± 1.14) min for lateral incision, (5.16 ± 2.07) min for Y-T enlargement and (11.09 ± 3.21) min for wedge excision, and all of them were significantly shorter than that of the sutured group.In the sutured group, all flaps survived except for 2 veins with poor blood flow were cut and re-anastomosed during the operation;1 flap with venous crisis within 72 hours after the operations was explored and replaced with the pectoralis major myocutaneous flap.All veins in the coupler group were successfully anastomosed in a single coupling procedure without anastomotic impatency, blood leak, vessel tearing and ring shedding.No vascular crisis occurred postoperatively.One patient underwent cervical haematoma 5 hours after the operation, and the flap blood supply was unaffected after the haematoma was removed.All flaps in the coupler group survived completely.Patients in both two groups were followed up 6 to 18 months.All flaps healed perfectly and no obvious surgical complications or microvascular anastomotic device rejection happened.Conclusion When anastomoses are carried out using microvascular anastomotic device between veins of different size, phleboplasties including lateral incision., Y-T enlargement and wedge excision can not only reduce the size discrepancy and the anastomosis time, but also ease the difficulty level and guarantee the patency of the venous anastomoses.Wedge excision enjoys the advantage of haemodynamics, and obstruction of venous reflux hardly occurred for size reduction.It should be considered preferentially when external jugular veins are used as the anastomotic vein of the recipient sites in head and neck reconstruction.

Objective To investigate the management of difficult recipient vessel preparation in microsurgical reconstruction for oral and maxillofacial defects with free flaps and to assess the clinical outcome.Methods A total number of 739 patients with oral and maxillofacial defects underwent consecutive free flap reconstruction with 761 free flaps from May,2012 to May,2015.There were 37 patients who could not find or lack of proper recipient vessels for microvascular anastomosis during operation.Among them,22 were recurrent oral cancer after tumor ablation,10 of them undrewent post-operative radiotherapy;5 were second primary oral cancer,7 diagnosed with osteoradionecrosis,and 3 suffered from oral and maxillofacial defect and deformity caused by trauma or inflammation.Forty free flaps including 23 anterolateral thigh flaps (ALT),10 fibular flaps and 7 radial forearm flaps were harvested.Methods and techniques used during the operation,instant patency rate after anastomosis,the overall survival rate of free flaps,and post-operative complications were recorded.Results Ninety-one anastomoses were performed between 87 pairs of vessels in 37 patients.Fifty recepient vessels were located on ipsilateral side of neck,and the most frequently used recipient vessels were those preserved or not being damaged in former operation and radiation,former transferred free flap vascular pedicles and residual ends of the ligated vessels.Thirty-seven recepient vessels were found on the contralateral side of neck.Thirty-one cases of long-pedicle flap harvesting,2 cases of vein and artery grafting,4 cases of vessel transposition,5 cases of phleboplasties,9 cases of end-to-side anastomoses,and 1 case of flow-through technique were applied in recipient vessels preparation alone or in combination.The patency rate of anastomosis during operation was 100％ and the overall survival rate of free flaps was 97.5％.Conclusion Recurrent oral cancer after tumor ablation,second primary oral cancer,osteoradionecrosis and deformity caused by trauma and inflammation are the main reasons of unsuitable recipient vessel conditions in microsurgical reconstruction for oral and maxillofacial defects.Methods including long-pedicle flap harvesting,venous grafting,vessel transposition,phleboplasty,end-to-side anastomosis and flow-through technique applied alone or in combination are still reliable choices for management of neck difficult recipient vessel preparation and anastomosis.

Objective To evaluate the clinical repair effects of the reconstruction of different vermilion tubercle after primary cleft lip repair.Methods According to the tight lip deformity and dif ferent degrees of defect of the vermilion tubercle and exposing the gums and the crown of the anterior incisors,178 patients after primary repair of the cleft lip from Department of Oral and Maxillofacial Surgery of Xiangya Hospital,Central South University were classified into the tight lip deformity and four grades of whistling deformities.According to different deformities and defects,the different operative techniques were used as follows:classic Abbé flap and modified Abbé flap were used for tight lip deformity;the bilateral advanced myomucosal flaps of lip were used for the grade Ⅰ;modified Abbé flap was used for repairing the grade Ⅱ and the grade Ⅲ whistling deformities;for grade Ⅳ whistling deformity,we mainly used classic Abbé flap.The follow-up after operation was performed,all patient's Cupid's bow,Cupid's bow peak,the vermilion tubercle and the height and width of the upper lip were observed.The scarring of the upper lip was also observed.Results The follow-up after operation was performed from six months to ninteen years,all the 187 patient's anatomical structures of the upper lip were nearly normal after recovery.The all patients showed an obvious Cupid's bow,Cupid's bow peak,the vermilion tubercle and the height and width of the upper lip.The relation of the upper lip and lower lip was harmonious.The scarring of the upper lip was not obvious 2 years after operation.Conclusions The different repair methods are chosen to repair different deformity and defect that has an important clinical value.

Objective To investigate the clinical features of malignant conversion of oral submucous fibrosis (OSF) and the application value of polyflaps perforator flaps in its surgical treatment.Methodis Ten patients who suffered from malignant conversion of OSF underwent simultaneous multiple defects reconstruction using polyflaps perforator flaps after radical tumor resection from August 2012 to October 2014.The fibrous bands leading to severe trismus near the pterygomandibular ligament as well as other intraoral lesions with malignant tendency were also resected besides from the known carcinoma.Patients with synchronous multiple primary cancers underwent radical resection and neck dissection of all other malignant lesions.The flaps were cut and tailored between adjacent perforators according to the amount and size of defects,forming several independent paddles for each defect reconstruction.Results Twenty-two defects were formed in 10 patients with malignant conversion of OSF.All of them were repaired with polyflaps anterolateral thigh (ALT) perforator flaps,including 8 cases of bipaddled ALT flaps and 2 cases of tripaddled ALT flaps.The total size of the flaps ranges from 3 cm ～ 8 cm × 6 cm ～ 24 cm,and the pedicle length ranges from 5 ～ 12 (9.7 ± 2.1)cm.Thirty-five perforator vessels were dissected,and each paddle included 1.6 perforators on average.All flaps survived after transplantation,and only 1 patient had infection of the neck incision.Post-operative adjuvant radio-chemotherapy was applied in 2 patients.All patients showed satisfactory accepting-site morphology with good speech function and swallowing recovery,and their trismus was improved during 6 to 30 (11.6 ± 3.7) months.One patient died from lung metastasis 10 months after the surgery while local recurrent or metastasis did not occur in others.The donor sites were closed primarily without skin-grafting,leaving no obvious surgical donor-site complications.Conclusions Polyflaps perforator flaps can reconstruct multiple and sizable complicate defects,increase month opening by one stage operation.They are worth being applied in surgical treatment of malignant conversion of OSF.

OBJECTIVETo investigate the effect on natural killer (NK) and cytotoxic T lymphocyte (CTL)-mediated cytotoxicity by genetic overexpression of MHC class I chain-related protein A (MICA) in oral squamous cell carcinoma (OSCC).

METHODSThe OSCC cells by genetic overexpression of MICA were detected to identify the biological features including cell growth curve, cell cycle distribution, plate clone forming rate and tumorigenicity in nude mice. The expression of natural killer group 2, member D (NKG2D) receptor and the cytotoxicity to target tumor cells of NK92 and CTL cells, which co-cultured with the transfected OSCC cells or the non-transfected or blank vector-transfected controls, were measured by flow cytometry and lactate dehydrogenase (LDH) release assay.

RESULTSThere was no difference in biological features before and after MICA gene transfection to OSCC cells. Flow cytometry and LDH release assay showed that MICA-overexpressed OSCC cells enhanced the cytotoxicity to target tumor cells and up-regulated the expression of NKG2D on NK92 and CTL (P<0.05).

CONCLUSIONMICA may be considered as a promising immunotherapy target of OSCC.

Animals ; Carcinoma, Squamous Cell ; Cell Line, Tumor ; Cytotoxicity, Immunologic ; Genetic Therapy ; Histocompatibility Antigens Class I ; Humans ; Killer Cells, Natural ; Mice ; Mice, Nude ; Mouth Neoplasms ; NK Cell Lectin-Like Receptor Subfamily K ; Staphylococcal Protein A ; T-Lymphocytes, Cytotoxic ; Transfection