Objective To summarize clinical application of the medial sural artery perforator pedicled flap for the coverage of soft tissue defects around the knee and upper one third of lower leg.Methods From May 2003 tO January 2007,16 patients(11 men,5 women)with soft tissue defects around the knee and upper one third of lower leg underwent reconstruction with the medial sural artery perforator pedicled flap.Of them,4 eases recipient site were located on the prepatellar region,2 cases were located on the anterolateral pateflar,1 case was located on the anteromedial patellar,and 9 cases upper one third oflowerleg.They ranged in age from 23 to 52 years(mean,36 years).The donor leg was ipsilateral in all cages. Results One ca8e sustained superficial infection postoperative and the gradual wound healed by daily wound dressings.All the flaps had survived completely without major complication with satisfactory clinical results. Follow-up period ranged from 3.0 months to 3.5 years(mean, 1.7 years)postoperatively.There was no remarkable donor site morbidity.All cases had good appearance and function in recipient site.There was no remarkable donor site morbidity. Conclusion The medial sural artery perforator flap is nourished by the musculocutaneous perforater of the medial sural artery.The flaps seem to has highly vascularize,a constant vascular anatomy and a long vascular pedicle.The flap is thin and suitable for the coverage of soft tissue defects around the knee and upper one third of lower leg.

Objective To investigate the mechanism of venous reverse-flow flap in the differentperiod after operation.Methods The rabbits wero randomly allocated into 3 groups.In group A,including saphenous artery and venae commutante.In group B,saphenous artery without venae commutante.In group C,surface seeping and saphenous artery and venae commutante.Flap appearance,intravenous pressure,vessel diameter,mierocircular and histological examination were mea8ured.Results The difference of introvenous pressure between group A.B and C was obvious.Reverse flow WaS found in group A and C group through microcirculation observation 2 hours post-operation.Venous valve lose efficacy while the vessel diameter wes at maximum just after the pressure peak.Conclusion Venous retrograde return in reverse-flow island flaps can be achieved more easily through"incompetent valves route"than through "communicating and collaterall by pass route".By pass route is a supplementary way.Surface seeping Can slighfly relieve the venous pressure but can cause infection.

Objective To report the operative technique and clinical experiences of the modified reversed superficial peroneal neurocutaneous island flaps for reconstruction of the ankle and foot.Methods According to the previous anatomical studies and our clinical experiences,we devised the reversed superficial peroneal neuroeutaneous island flap based on the descending branch of the distal perforator of the peronealrtery and its venae comitantes,and covered the soft defect of the ankle and foot with it.Results Twenty-one of the 23 flaps survived completely without complications,while the other two occurred marginal necrosis.The maximum surface of the flap in our series was 12 cm×13 cm.and the minimum one was 5 cm×4 cm.The length of the pedicle ranged from 5 cm to 10 cm.The texture of the flaps was good,while the cosmetic and function of them were evaluated as acceptable in all cased after 6 to 21 months follow-up.Conclusion The reversod superficial peroneal neurocutaneous island flaps is a versatile,reliable procedure useful in reconstruction of the ankle and foot.

Objective To observe the curative effect of the treatment of serious femoral neck fractures with vascularized great trochanter bone flap transposition in young adults.Methods Twenty-nine cases were investigated.In which Garden type Ⅲ were 10 and type IV 19.There were 12 ca$,e8 of fresh fractures and 17 old fractures.According to the X-ray films of old fractures,caput femoris necrosis occurred in 7 patients.Tibial tubercle traction was carried out as preoperative preparation as soon as the patients were sent to hospital.The operation was performed by combining hollow-lag-svcrews fixing with vascularized great trochanter bone flap transposition.Results The foUow-up lasted 39 to 84 months,with an average of 54 months.The patients suffering from fresh femoral neck fractures all recovered and no necrosis WaS found.The healing time was between 4 to 6 months,with an average of 4.5 months or so.And old fractures were all healed up almost within the same time.The recovery time of patients who suffered from fractures and necrosis was with an average of 12.5 months.Of 10 cases of old fractures without caput femoris necrosis prior to operation,necrosis occurred in 3 c88es.The functions of hip joints of 15 cases completely recoveTed,and 12 patients were partially restricted.Another 2 patients could not squat because the flexion function was seriously restricted.The crispation of limbs was well corrected.According to Harris standard.the postoperative mean SCOre is 89.2.Concision It is good for treatment of serious femoral neck fractures with vascularized great trochanter bone flap transposition in young adults.

Objective To study the first metacarpal dorsal artery anatomy,and explore the flap based on the branch chain of the first metacarpal dorsal artery.To provide anatomical basis for clinical application of the flap.Methods The origin,courses and distribution of the branch chain of the first metacarpal dorsal artery from 8 fresh hand specimens perfused by red latex were explored from January,2015 to December,2016.Results There was a dorsal artery network in the dorsal side of the first metacarpal.The radial and ulnar dorsal artery of the first metacarpal originated from the radial artery and along the first metacarpal lateral margin to go down.The initial diameter of the radial dorsal artery was (0.82±0.06)mm.The initial diameter of the ulnar dorsal artery was (0.74±0.05) mm.And anastomosed with the dorsal branches of the thumb inherent arteries.The both inherent arteries of thumb give off dorsal branches count (2.62±0.34).The initial diameter of proximal dorsal branch was (0.32±0.03) mm.The initial diameter of distal dorsal branch was (0.24±0.08) mm.Conclusion The radial and ulnar dorsal vascular chain of the first metacarpal were constant.The anastomosed branches with the dorsal branches of the thumb inherent arteries were abundant.The free flap or retrograde flap based on the vsscular chain has reliable blood supply.And without destroyed the main artery of thumb.

Objective To discuss the clinical effect of Da Vinci robot-assisted free fibula flap for the management of mandibular and mouth segmental defect.Methods There was a patient with malignant neoplasm of lower gum,which underwent robot-assisted free fibula flap for the management of mandibular and mouth segmental defect,was analyzed.The surgery was divided into two groups:a group resected the primary tumors,another group cut fibula free flap.Use of Da Vinci robotic surgical system for vascular anastomosis and suture of the oral mucosa.Results Four weeks after surgery,the free fibula flap survived completely.There was no infection in the mouth.The patient can walk freely and eating semifluid.Conclusion The Da Vinci robotic surgical system is a stable,minimally invasive,clear and safe method for microsurgery.

Objective To investigate the effects of human amniotic membrane on the survival of the crossboundary perforator flap in rats through distal subcutaneous implantation.Methods From February,2016 to December,2016,38 SD rats weighing 270-300 g were randomly divided into experimental group and control group (n=19).A three-territory perforator flap (3 cm× 10 cm) with the iliac artery as the pedicel elevated on the right dorsum of the rats.Experiment group,a section of amnion was sutured to the distal subcutaneous of the flap and then the flap was sutured back to its donor site.Control group,after the flap elevated,directly sutured back to its donor site.The blood flow of the pedicel were detected by laser Doppler flowmetry at the day before surgery,1 day after surgery,3 and 7 days after surgery,with 3 rats in every group.When the rats were anesthetized,biopsies were taken from the choke area Ⅱ at the day before surgery,3 and 7 days after surgery,with 9 rats in every group.When the rats were anesthetized,HE was used to compare the diameter size of the artery and vein at the same site.At day 7,measure the survival area of the flap,and 3 of them observe the vessel of the flap by lead oxide-gelatine technique.Results The survival rate of the experimental group and the control group after 7 days were (89.09±4.23)％ and (74.56-±5.59)％ respectively,the experimental group was significantly higher than that of the control group (t=5.48,P=0.00).X-ray showed that 7 days after operation,the pedicel of iliac artery in the experimental group was bigger than that in the control group.The blood flow detection showed that the blood flow of the experimental group was higher than that of the control group (t=2.39,3.06;P=0.03,0.00,respectively) at day 1 and day 3 after surgery.Hematoxylin eosin staining showed that arteriovenous tube diameter at the Choke Ⅱ were gradually increased on the day3 and day7 after surgery in both group,but the experimental group diameter expanded multiple was higher than that of control group (t=3.52,3.50;P=0.02,0.02,respectively).Conclusion Human Amnion subcutaneous embedding may improve the blood flow of the vascular pedicle,expand the microvascular at Choke area Ⅱ,improve microcirculation,as a result to promote the survival of cross perforator flap,while the mechanism is needed to understanding.

Objective To observe enhancing effect of nerve regeneration on peripheral nerve defect models bridged by VPA/PRGD conduit combined with adipose derived mesenchymal stem cells (ADSCs).Methods From February,2013 to August,2014,the hollow nerve scaffolds were constructed by PRGD and VPA.The activity of AD SCs proliferation was tested through the method of CCK-8.Moreover,the effect of VPA/PRGD conduit combined with ADSCs on peripheral nerve regeneration was evaluated,as well as recovery of motor function following sciatic nerve resection in rats.A 10 mm sciatic nerve deficit was created in a rat model and bridged by VPA/PRGD conduit combined with ADSCs (group A),VPAfPRGD conduit (group B) and autograft (group C) respectively.The results was analyzed by the method of group t-test of SPSS 19.0.Results At 3 d,6 d,9 d,CCK-8 test showed that the OD value of groups VPA/PRGD and control has no significance(P ＞ 0.05).At 12 weeks after surgery,the numbers of regenerated nerve proximal to the tube of group A (268±7.48),group B (269±6.86) and group C (271±7.55),had no significant difference between two groups(P ＞ 0.05).The numbers of regenerated nerve in the tube of group A (257±6.19) and group C (260±5.60) were significantly higher than those of group B (229±5.08) (P ＜ 0.05).There was no significant between groups A and C (P ＞ 0.05).The numbers of regenerated nerve distal to the tube of group A (246±5.89) and group C (247±5.02) were significantly higher than those of group B (214±7.55) (P ＜ 0.05).There was no significant between groups A and C (P ＞ 0.05).Conclusion These promising results illustrate that this novel VPA/PRGD combined with ADSCs conduit can obviously facilitate the regeneration of injured nerve in rats.

Objective To discuss the clinical characteristic of middle ear malformation with cholesteatoma.Methods From September,2011 to November,2016,23 cases of middle ear malformation with cholesteatoma were collected.Their symptoms,ENT examination,temporal bone high resolution computed tomography (HRCT) and intraoperative findings were analyzed.Results All 23 patients had hearing loss.90.0％ patients had ear discharge and tinnitus.86.96％ patients had perforation in pars flaccida of tympanic membrane.95.7％ patients had poor mastoid gasification.73.9％ patients had undeveloped or dysplastic tympanic antrum.100％ patients had destruction of the ossicular chain.56.5％ patients had malformation of the ossicular chain.52.2％ patients had exposed facial nerve.30.4％ patients had hyperplasia of the attic bone.Conclusion The symptoms and physical examinations of middle ear malformation with cholesteatoma are the same as middle ear cholesteatoma.Poor mastoid gasification can usually be detected on temporal bone HRCT.The most common malformation is dysplastic tympanic antrum,followed by malformation of the ossicular chain,exposed facial nerve and hyperplasia of the attic bone.Temporal bone HRCT can indicate the malformation and destruction quite well.

Objective To investigate the methods and results of hand reconstruction by transplanting the fostered residual finger and the second toe,which share the same blood supply system.Methods From January,2014 to January,2016,3 cases with destructive hand injuries in our hospital;and debridement was performed in one session during the early stage of trauma,with skin grafting to cover the wrist stump and foster the residual finger to a branch of the dorsalis pedis artery.The first dorsal metatarsal artery around the toe web was identified and then gradually isolated proximally with dissection of the branches of the dorsalis pedis artery supplying the fostered finger until the convergence of the two blood vessels.Then,reconstructed hand by residual finger and combined second toe transplantation.Results After a follow-up period of 3 months to 2 years,the reconstructed hand had a good appearance and was able to complete basic mundane actions.The function of the limb was restored to a large extent andthe patient was satisfied with the reconstructed hand.Conclusion Transfer of a fostered residual finger and combined second toe which have the same blood supply system for hand reconstruction as a new method need to anastomose only one set of arteries,and it is feasible with the good appearance and function of the reconstructed hand.