1.Effects of flumazenil and naloxone on scopolamine-induced impairment of spatial working memory in rats
Dahai TAN ; Yan ZHANG ; Zheng CHEN
Chinese Journal of Anesthesiology 2010;30(3):320-323
Objective To investigate the effects of flumazenil and naloxone on scopolamine-induced impairment of spatial working memory in rats.Methods Forty pathogen-free SD rats weighing 160-200 g were randomly divided into 4 groups(n=10 each):group I control(group C);group IIscopolamine(group S);group III flumazenil+scopolamine(group SF)and group IV naloxone+scopolamine(group SN).Scopolamine 0.8 mg/kg was administered IP once a day for 3 consecutive days in group II-IV.In group SF and SN flumazenil 0.5 mg/kg and naloxone 2 mg/kg were administered IP respectively once a day for 3 consecutive days in addition to scopolamine.Thirty minutes after last IP administration,cognitive function was assessed using Y-maze.The animals were killed after cognitive function assessment and bilateral hippocampi Were isolated for determination of mAChRM1 mRNA expression(by RT-PCR)and detection of ChAT positive neurons(by immuno-histochemistry).Results Cognitive dysfunction developed in group S as compared with control group and was ameliorated in group SF and SN.The number of ChAT positive neurong and mAChRM1 mRNA expression were significantly decreased in group S compared with control group and were significantly higher in group SF and SN than in group S.Conclusion Flumazenll and naloxone can ameliorate the scopolamine-induced impairment of spatial working memory by improving cholinergic neuron function.
2.Formation mechanism of the gallbladder cholesterol polyps
Dahai JIAO ; Mingliang WANG ; Minhua ZHENG
International Journal of Surgery 2008;35(12):841-844
Cholesterol polyposis of the gallbladder is a metabolic disorder of cholesterol and characterized by the deposit of cholesterol esters and other lipids in the lamina propria of gallbladder.The pathogenesis is complicated which may involve various factors,and probably associated with the alteration of polygene expression,but at this moment the true nosogenesis is still unclear.
3.The value of Tei index for evaluation of hemodynamics after interventional therapy of patent ductus arteriosus
Guiming YANG ; Liyun ZHENG ; Xiaohui QI ; Dahai ZHANG ; Sheng ZHAO
Chinese Journal of Postgraduates of Medicine 2021;44(3):259-264
Objective:To study the clinical value of left ventricle Tei index in evaluating hemodynamics after interventional therapy of patent ductus arteriosus (PDA).Methods:From May 2017 to May 2019, 50 children with PDA who underwent interventional therapy (PDA group) and 27 healthy children (healthy control group) in Anhui Provincial Children’s Hospital were selected. The left ventricle Tei index, plasma brain natriuretic peptides (BNP), left ventricular end-diastolic dimension (LVDD), left ventricular ejection fraction (LVEF) were compared between 2 groups.Results:The left ventricle Tei index was not correlated with heart rate and age in 2 groups ( P>0.05). The left ventricle Tei index before operation in PDA group was significantly lower than that in healthy control group: 0.20(0.16, 0.25) vs. 0.27(0.20, 0.30), and there was statistical difference ( P<0.05). In PDA group, the left ventricle Tei index immediately, 3 d, 1 month and 3 months after operation was significantly higher than before operation: 0.38(0.29, 0.47), 0.32(0.26, 0.40), 0.30(0.27, 0.35) and 0.32(0.26, 0.37) vs. 0.20(0.16, 0.25), and there was statistical difference ( P<0.05); the plasma BNP immediately after operation was significantly lower than before operation: 288 (126, 433) ng/L vs. 582 (303, 1 675) ng/L, and there was statistical difference ( P<0.05); the LVDD 3 months after operation was significantly lower than before operation: (3.03 ± 0.54) cm vs. (3.38 ± 0.51) cm, and there was statistical difference ( P<0.05); the LVEF immediately after operation was significantly lower than before operation: (54.24 ± 6.09)% vs. (59.45 ± 5.93)%, the LVEF 1 and 3 months after operation was significantly higher than that immediately after operation: (63.18 ± 4.71)% and (65.46 ± 4.78)% vs. (54.24 ± 6.09)%, and there were statistical differences ( P<0.05). The left ventricle Tei index before operation was negatively correlated with inner diameter of PDA and plasma BNP ( r = -0.362 and -0.388, P = 0.013 and 0.009), and there was no correlation between LVDD and LVEF ( r = -0.192 and -0.283, P = 0.229 and 0.053); the differences of Tei index before operation and immediately after operation (ΔTei) was positively correlated with inner diameter of PDA ( r = 0.325, P = 0.030), and there was no correlation with BNP, LVDD and LVEF ( r = 0.234, 0.283 and -0.039, P = 0.126, 0.076 and 0.798). Conclusions:The left ventricle Tei index can quickly and accurately assess the change of hemodynamics after interventional therapy of PDA.
4.Effects of adipose-derived mesenchymal stem cells over-expressing glial cell line-derived neurotrophic factor on electrically injured sciatic nerve of rats.
Yang CHEN ; Hu DAHAI ; Zheng ZHAO ; Bai XIAOZHI ; Wang YAOJUN ; Tang CHAOWU
Chinese Journal of Burns 2015;31(3):199-204
OBJECTIVETo observe the effects of adipose-derived mesenchymal stem cells (ADSCs) with continous over-expression of glial cell line-derived neurotrophic factor (GDNF) on the motor function recovery and nerve regeneration of sciatic nerve of rats after electrical injury.
METHODSFive SD rats were collected to prepare ADSCs with over-expression of GDNF. One hundred and fifty SD rats were divided into normal control group (N), GDNF-ADSCs group (GA), ADSCs group (A), GDNF group (G), and physiological saline group (P) according to the random number table, with 30 rats in each group. Rats in group N were routinely fed without treatment, and rats in the other 4 groups were inflicted with electrical injury on sciatic nerve of thigh of the right hind leg. Rats in groups GA, A, G, and P were respectively injected with 100 µL suspension of ADSCs with over-expression of GDNF (1 x 10(7) cells per mL), 100 [µL ADSCs suspension (1 x 10(7) cells per mL), 100 µL GDNF solution (100 mg/L) , and 100 µL physiological saline to the surface of the injured nerves immediately after injury. Six rats of each group were collected for measuring hind limb stride from post injury week (PIW) 1 to 8, and morphology of the sciatic nerves was observed in PIW 8. In PIW 4, the protein expression of GDNF of sciatic nerves of the rest rats in each group was determined with Western blotting. Data were processed with one-way analysis of variance, analysis of variance of repeated measurement, and SNK test.
RESULTSCompared with that of group N, the hind limb stride values in groups GA, A, G, and P were significantly lower at each time point (with P values below 0.05). Compared with those of group P, the hind limb stride values in group GA from PIW 3 to 8, in group A in PIW 3, 5, and 7, and in group G in PIW 3, 5, 7, and 8 were significantly longer (with P values below 0.05). The hind limb stride values in group GA from PIW 4 to 8 were respectively (10.83 ± 0.97), (13.25 ± 1.40), (12.86 ± 1.42), (14.06 ± 1.50), and (15.09 ± 1.17) cm, which were significantly longer than those in group A [(8.90 ± 0.82), (9.03 ± 0.57), (9.27 ± 0.36), (9.86 ± 0.36), and (9.52 ± 0.58) cm] and group G [(8.87 ± 0.69), (8.51 ± 1.18), (9.34 ± 0.87), (9.76 ± 0.67), and (9.50 ± 1.22) cm], with P values below 0.05. Compared with that of group N, the number of myelinated nerve fibers of sciatic nerves was obviously decreased in group P but obviously increased in groups GA, A, and G; the diameter of axons was obviously shorter, and the myelin thickness was obviously increased in groups GA, A, G, and P in PIW 8 (with P values below 0.05). The number of myelinated nerve fibers in group GA was 31.2 ± 0.8, which was significantly higher than that in group A (23.7 ± 2.7), group G (22.3 ± 2.7), or group P (9.3 ± 2.8), with P values below 0.05. The diameter values of axons among groups P, A, G, and GA were similar (with P values above 0.05). The myelin thickness of rats in group GA was (3.41 ± 0.34) µm, which was significantly thicker than that in group A [(2.64 ± 0.37) µm] or group G [(2.41 ± 0.34) µm], with P values below 0.05. In PIW 4, the protein expression of GDNF of sciatic nerves was significantly higher in groups P, A, G, and GA than in group N (with P values below 0.05), and the protein expression of GDNF in group GA was significantly higher than that in group P, A, or G (with P values below 0.05).
CONCLUSIONSADSCs over-expressing GDNF protein can obviously promote the motor function recovery and nerve regeneration of sciatic nerve of rats after electrical injury.
Adipose Tissue ; Animals ; Electrophysiology ; Glial Cell Line-Derived Neurotrophic Factor ; genetics ; metabolism ; Mesenchymal Stem Cell Transplantation ; methods ; Mesenchymal Stromal Cells ; metabolism ; Nerve Crush ; Nerve Regeneration ; physiology ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve ; pathology ; physiology
5.Analysis of diagnosis and treatment of 23 infants with atrial tachycardia
Guiming YANG ; Rong JIANG ; Sheng ZHAO ; Liyun ZHENG ; Dahai ZHANG ; Yungong WANG ; Xiaobi HUANG ; Jun GUO
Chinese Journal of Postgraduates of Medicine 2019;42(3):204-207
Objective To study the clinical characteristics, respond of treatment and prognosis in infants with atrial tachycardia (AT). Methods The clinical data of 23 infants with AT from August 2014 to November 2016 were retrospectively analyzed. The respond of treatment and prognosis were observed. Results Of all the 23 infants with AT, incessant AT was in 5 cases, and paroxysmal AT was in 18 cases. There were 13 infants diagnosed with AT combined with cardiac insufficiency, and among them, 5 cases were combined with tachycardia induced cardiomyopathy (TIC). Echocardiography showed that atrial septal defect in 3 cases, patent foramen oval in 6 cases, ventricular septal defect in 1 case, ventricular septal defect combined with patent foramen oval in 2 cases, ventricular septal defect combined with atrial septal defect in 1 case, and ventricular septal defect combined with coarctation of the aorta in 1 case. The curative effect was excellent in 11 cases, effective in 8 cases, and ineffective in 4 cases at discharge. There was no statistical difference in curative effect between patients with normal cardiac function and cardiac insufficiency at discharge (P>0.05). The infants were followed up for 12 months, AT disappeared in 19 cases, 1 case progressed to sick sinus syndrome, and 3 cases were lost in follow-up. Conclusions AT can be insidious in infants, but with a favorable prognosis if treated with cardiotonic drugs and antiarrhythmic drugs during the short and mid-term follow-up. Long-term follow-up should be taken to learn more about the prognosis.
6.Expressions and effects of autophagy-related genes in bleomycin-induced skin fibrosis of mice
Xiang HE ; Jie LI ; Jiaqi LIU ; Zhao ZHENG ; Dahai HU
Chinese Journal of Burns 2020;36(5):346-356
Objective:To investigate the expressions and effects of autophagy-related genes in bleomycin-induced skin fibrosis of mice.Methods:(1) Totally 72 male BALB/c mice aged 6 weeks were divided into blank control group, simple phosphate buffer solution (PBS) group, and bleomycin group according to the random number table, with 24 mice in each group. Mice in blank control group received no treatment, and 100 μL of PBS and bleomycin (1 mg/mL) were respectively injected subcutaneously in the back skin of mice in simple PBS and bleomycin group, once a day for 28 days. On injection day (ID) 7, 14, 21, and 28, 6 mice in each group were collected to observe the skin change on the back of mice with naked eyes. After the observation, the mice were sacrificed and skin tissue on the back was taken. Skin tissue of mice on ID 28 was collected to measure the thickness of skin tissue by routine hematoxylin-eosin staining and observe skin tissue morphology by Masson staining. Skin tissue on ID 7, 14, 21, and 28 was taken to detect content of hydroxyproline by enzyme linked immunosorbent assay, and mRNA and protein expressions of p62, microtubule-associated protein 1 light chain 3 Ⅱ (LC3 Ⅱ) and Beclin-1 were detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction and Western blotting, respectively. (2) Skin tissue of mice in blank control group in experiment (1) was taken to culture fibroblasts (Fbs) in 3rd-6th passages. The cells were divided into blank control group, simple PBS group, and bleomycin group according to the random number table, with 6 wells in each group. Cells in blank control group were not stimulated, and cells in simple PBS group and bleomycin group were stimulated with 20 μL of PBS and bleomycin (1 mg/mL) for 72 h, respectively. Cellular immunofluorescence staining was used to observe the expression of LC3 Ⅱ. Data were statistically analyzed with analysis of variance of factorial design, one-way analysis of variance, t test, and Bonferroni correction. Results:(1) Skin on the back of mice in blank control group and simple PBS group was thin and ruddy, and the veins were clear on ID 7, 14, 21, and 28. Several raised ridges were visible on the puncture site of mice in simple PBS group from ID 14. Skin on the back of mice was ruddy, with several raised ridges visible on the puncture site of mice in bleomycin group on ID 7, the skin turned slightly white on ID 14, the skin turned white obviously with unclear surrounding blood vessels on ID 21, and the skin turned white and the surrounding blood vessels could not be recognized on ID 28. (2) On ID 28, the skin thicknesses of mice in blank control group and simple PBS group were similar ( t=0.79, P>0.05). Compared with that in blank control group and simple PBS group, the skin thickness of mice in bleomycin group was significantly increased ( t=0.50, 0.50, P<0.01). (3) On ID 28, the skin tissue structure of mice in blank control group and simple PBS group was similar, with a small amount of orderly arranged collagen and evenly distributed hair follicle; the number of collagen of skin in mice of bleomycin group was increased obviously and arranged disorderly, and the number of hair follicle was decreased significantly. (4) On ID 7, 14, 21, and 28, the content of hydroxyproline in the skin tissue of mice in bleomycin group was significantly higher than that in blank control group and simple PBS group ( t=0.99, 0.98, 0.50, 0.51, 0.50, 0.50, 0.52, 0.51, P<0.05 or P<0.01). (5) On ID 7, p62 mRNA expression in the skin tissue of mice in bleomycin group was significantly lower than that in simple PBS group ( t=0.93, P<0.05). On ID 14 and 21, the mRNA expressions of p62, LC3 Ⅱ, and Beclin-1 in the skin tissue of mice in bleomycin group were significantly higher than those in blank control group ( t=0.74, 0.70, 0.58, 0.49, 0.51, 0.74, P<0.05) and simple PBS group ( t=0.94, 0.65, 0.65, 0.77, 0.49, 0.51, P<0.05). On ID 28, the mRNA expressions of p62 and Beclin-1 in the skin tissue of mice in bleomycin group were significantly lower than those in blank control group ( t=0.50, 0.44, P<0.05) and simple PBS group ( t=0.97, 0.55, P<0.05), and that of LC3 Ⅱ was significantly higher than that in blank control group and simple PBS group, respectively ( t=0.51, 0.98, P <0.01). (6) On ID 7, 14, 21, and 28, the protein expressions of LC3 Ⅱ in blank control group, simple PBS group, and bleomycin group were 0.167±0.042, 0.122±0.016, 0.553±0.078, 0.118±0.035, 0.120±0.023, 0.117±0.061, 0.581±0.039, 0.159±0.065, 0.233±0.027, 0.304±0.031, 1.020±0.010, 0.089±0.045. On ID 14, the protein expressions of p62 and Beclin-1 in the skin tissue of mice in bleomycin group were significantly higher than those in blank control group ( t=0.86, 0.89, P<0.05) and simple PBS group ( t=0.42, 0.89, P<0.05). On ID 21, the protein expressions of p62, LC3 Ⅱ, and Beclin-1 in the skin tissue of mice in bleomycin group were significantly higher than those in blank control group and simple PBS group ( t=0.82, 0.45, 0.50, 0.79, 0.51, 0.50, P<0.01). On ID 28, the protein expressions of p62, LC3 Ⅱ, and Beclin-1 in the skin tissue of mice in bleomycin group were significantly lower than those in blank control group and simple PBS group ( t=0.77, 0.54, 0.52, 0.50, 0.51, 0.50, P<0.05). (7) After culture for 72 h, the expression of LC3 Ⅱ in Fbs of bleomycin group was significantly lower than that of blank control group and simple PBS group, respectively. Conclusions:In the process of bleomycin stimulating skin fibrosis, autophagy-related genes increase firstly and then decrease. When the autophagy process is activated, it is expected to reverse the process of skin fibrosis.
7.Microsurgical treatments of total scalp avulsion
Ting ZHANG ; Fu HAN ; Jiaqi LIU ; Peng YAN ; Dahai HU ; Juntao HAN ; Zhao ZHENG
Chinese Journal of Plastic Surgery 2020;36(6):650-654
Objective:To investigate the treatment of total scalp avulsion with microsurgery and its clinical effects.Methods:From December 2013 to November 2019, four patients who suffered from total scalp avulsion were admitted in the Department of Burns and Cutaneuos Surgery, the First Affiliated Hospital of the Air Force Medical University. All cases were female, aged 31-56 years old and with varying degrees of cranial exposure, and were treated through microsurgery for scalp repair and reconstruction. 1 case received in situ replantation of the avulsed scalp by microvascular anastomosis 24 h after injury. 2 cases with different degrees cranial bone exposure and without the indication of replantation received free latissimus dorsi flap transplantation for covering the cranial wound, and biological dressing for covering the latissimus dorsi flap and other scalp defect wound. After that, the wound was repaired with intermediate split thickness skin grafting in second stage operation. 1 patient, who was admitted to our unit with necrosis of the total scalp after direct suturing in a different unit, was treated with microsurgical transplantation of laparoscopically harvested free omentum, and covered the omentum with biological dressings, combined with second stage skin grafting.Results:All cases were followed up for 2 months to 3 years. 1 case who was treated with in situ replantation of the avulsed scalp with microvascular anastomosis had satisfactory scalp survival, good hair regeneration and no obvious scar formation. After free latissimus dorsi flap transplantation combined with autologous skin grafting in 2 cases, the head was relatively bloated, with scarred scalp and hair loss, as well as high donor site morbidity. The case, who received free omentum transplantation combined with autologous skin grafting, was plump and smooth in head appearance and soft in texture. There was little morbidity to the abdominal donor site and no obvious abdominal complications.Conclusions:In situ replantation with microsurgical anastomosis is the best choice of total avulsed scalp. For the cases with extensive cranial wounds and no indication of replantation, free latissimus dorsi flap and laparoscopically harvested free greater omentum transpltantion combined with autologous skin grafting also could obtain satisfactory clinical effects.
8.Microsurgical treatments of total scalp avulsion
Ting ZHANG ; Fu HAN ; Jiaqi LIU ; Peng YAN ; Dahai HU ; Juntao HAN ; Zhao ZHENG
Chinese Journal of Plastic Surgery 2020;36(6):650-654
Objective:To investigate the treatment of total scalp avulsion with microsurgery and its clinical effects.Methods:From December 2013 to November 2019, four patients who suffered from total scalp avulsion were admitted in the Department of Burns and Cutaneuos Surgery, the First Affiliated Hospital of the Air Force Medical University. All cases were female, aged 31-56 years old and with varying degrees of cranial exposure, and were treated through microsurgery for scalp repair and reconstruction. 1 case received in situ replantation of the avulsed scalp by microvascular anastomosis 24 h after injury. 2 cases with different degrees cranial bone exposure and without the indication of replantation received free latissimus dorsi flap transplantation for covering the cranial wound, and biological dressing for covering the latissimus dorsi flap and other scalp defect wound. After that, the wound was repaired with intermediate split thickness skin grafting in second stage operation. 1 patient, who was admitted to our unit with necrosis of the total scalp after direct suturing in a different unit, was treated with microsurgical transplantation of laparoscopically harvested free omentum, and covered the omentum with biological dressings, combined with second stage skin grafting.Results:All cases were followed up for 2 months to 3 years. 1 case who was treated with in situ replantation of the avulsed scalp with microvascular anastomosis had satisfactory scalp survival, good hair regeneration and no obvious scar formation. After free latissimus dorsi flap transplantation combined with autologous skin grafting in 2 cases, the head was relatively bloated, with scarred scalp and hair loss, as well as high donor site morbidity. The case, who received free omentum transplantation combined with autologous skin grafting, was plump and smooth in head appearance and soft in texture. There was little morbidity to the abdominal donor site and no obvious abdominal complications.Conclusions:In situ replantation with microsurgical anastomosis is the best choice of total avulsed scalp. For the cases with extensive cranial wounds and no indication of replantation, free latissimus dorsi flap and laparoscopically harvested free greater omentum transpltantion combined with autologous skin grafting also could obtain satisfactory clinical effects.
9.Microsurgical treatments of total scalp avulsion
Ting ZHANG ; Fu HAN ; Jiaqi LIU ; Peng YAN ; Dahai HU ; Juntao HAN ; Zhao ZHENG
Chinese Journal of Plastic Surgery 2020;36(6):650-654
Objective:To investigate the treatment of total scalp avulsion with microsurgery and its clinical effects.Methods:From December 2013 to November 2019, four patients who suffered from total scalp avulsion were admitted in the Department of Burns and Cutaneuos Surgery, the First Affiliated Hospital of the Air Force Medical University. All cases were female, aged 31-56 years old and with varying degrees of cranial exposure, and were treated through microsurgery for scalp repair and reconstruction. 1 case received in situ replantation of the avulsed scalp by microvascular anastomosis 24 h after injury. 2 cases with different degrees cranial bone exposure and without the indication of replantation received free latissimus dorsi flap transplantation for covering the cranial wound, and biological dressing for covering the latissimus dorsi flap and other scalp defect wound. After that, the wound was repaired with intermediate split thickness skin grafting in second stage operation. 1 patient, who was admitted to our unit with necrosis of the total scalp after direct suturing in a different unit, was treated with microsurgical transplantation of laparoscopically harvested free omentum, and covered the omentum with biological dressings, combined with second stage skin grafting.Results:All cases were followed up for 2 months to 3 years. 1 case who was treated with in situ replantation of the avulsed scalp with microvascular anastomosis had satisfactory scalp survival, good hair regeneration and no obvious scar formation. After free latissimus dorsi flap transplantation combined with autologous skin grafting in 2 cases, the head was relatively bloated, with scarred scalp and hair loss, as well as high donor site morbidity. The case, who received free omentum transplantation combined with autologous skin grafting, was plump and smooth in head appearance and soft in texture. There was little morbidity to the abdominal donor site and no obvious abdominal complications.Conclusions:In situ replantation with microsurgical anastomosis is the best choice of total avulsed scalp. For the cases with extensive cranial wounds and no indication of replantation, free latissimus dorsi flap and laparoscopically harvested free greater omentum transpltantion combined with autologous skin grafting also could obtain satisfactory clinical effects.
10.Microsurgical treatments of total scalp avulsion
Ting ZHANG ; Fu HAN ; Jiaqi LIU ; Peng YAN ; Dahai HU ; Juntao HAN ; Zhao ZHENG
Chinese Journal of Plastic Surgery 2020;36(6):650-654
Objective:To investigate the treatment of total scalp avulsion with microsurgery and its clinical effects.Methods:From December 2013 to November 2019, four patients who suffered from total scalp avulsion were admitted in the Department of Burns and Cutaneuos Surgery, the First Affiliated Hospital of the Air Force Medical University. All cases were female, aged 31-56 years old and with varying degrees of cranial exposure, and were treated through microsurgery for scalp repair and reconstruction. 1 case received in situ replantation of the avulsed scalp by microvascular anastomosis 24 h after injury. 2 cases with different degrees cranial bone exposure and without the indication of replantation received free latissimus dorsi flap transplantation for covering the cranial wound, and biological dressing for covering the latissimus dorsi flap and other scalp defect wound. After that, the wound was repaired with intermediate split thickness skin grafting in second stage operation. 1 patient, who was admitted to our unit with necrosis of the total scalp after direct suturing in a different unit, was treated with microsurgical transplantation of laparoscopically harvested free omentum, and covered the omentum with biological dressings, combined with second stage skin grafting.Results:All cases were followed up for 2 months to 3 years. 1 case who was treated with in situ replantation of the avulsed scalp with microvascular anastomosis had satisfactory scalp survival, good hair regeneration and no obvious scar formation. After free latissimus dorsi flap transplantation combined with autologous skin grafting in 2 cases, the head was relatively bloated, with scarred scalp and hair loss, as well as high donor site morbidity. The case, who received free omentum transplantation combined with autologous skin grafting, was plump and smooth in head appearance and soft in texture. There was little morbidity to the abdominal donor site and no obvious abdominal complications.Conclusions:In situ replantation with microsurgical anastomosis is the best choice of total avulsed scalp. For the cases with extensive cranial wounds and no indication of replantation, free latissimus dorsi flap and laparoscopically harvested free greater omentum transpltantion combined with autologous skin grafting also could obtain satisfactory clinical effects.