Objective:To investigate the principle of treatment and the preventive measures of flap necrosis after total auricle reconstraction in children.Methods:From 1992 to 2002,the flap necrosis occured in 4 of 20 cases(17 ears) undergoing operation of total auricle reconstraction,the areas of necrosis was ranged from 3?1.5cm to 6?5cm. 4 cases were repaired by using remnant temporal superficial fascia flaps combining with full-thickness skin graft and random upper arm flap,respectively.Results:The wounds of 4 cases were completely healed.Conclusion:The principle of treatment is to remove necrotic tissue and to use remnant temporal superficial fascia flap with full-thickness skin graft to cover the wounds.The key of preventing flap necrosis is to maintain the blood supply of temporal superficial fascia flap.

A visualized reformation was carried out in the multimedia coursewares through collecting and adding the related pictures and professional video information.Through the teach-ing practice in the last three years,we have got the opinion from the students that by overcom-ing the stiffness and dullness of the old"General",the reformed"General"obviously has sur-passed the old"General"in teaching quality.

Objective To discuss drug resistance of wound-isolated pseudomonas aeruginosa and its correlation with use of antibiotics in children,for guiding the clinical use of antibiotics.Methods One hundred and forty wounded children admitted from January 2009 and December 2013 were collected in the study.There were 97 males and 43 females,aged (5.4 ± 2.6) years.All were victims of road traffic accidents.Distribution of bacteria isolated from the wound and drug resistance of pseudomonas aeruginosa were detected.Twenty-seven children with pseudomonas aeruginosa infection were divided into imipenem-resistant group (n =7) and non-imipenem resistant group (n =20).Drug resistance and application intensity of antibiotics were compared between the two groups.Results A total of 64 pathogens were isolated from the wound culture.Top five bacteria detected were acinetobacter baumannii,pseudomonas aeruginosa,enterobacter cloacae,escherichia coli and staphylococcus epidermidis.Pseudomonas aeruginosa showed resistance to β-lactam antibiotics,tetracyclines,chloram-phenicol and sulfanilamide.Drug resistance of piperacillin tazobactam (64.7％),meropenem (100％),ceftazidime (64.7％) and piperacillin (76.5％) in imipenem-resistant group were all 40％ higher than that in nonimipenem resistant group (P ＜ 0.05).Imipenem-resistant group versus non-imipenem resistant group revealed no significant differences in drug resistant rate of azactan (76.5％,39.0％),cefepime (70.6％,29.3％) and gentamicin (35.3％,17.1％) (P ＞ 0.05).There was no significant difference in total application intensity of antibiotics between the groups (P ＞ 0.05).Conclusions Wound-isolated pseudomonas aeruginosa in children is multidrug resistant.Thus bacterial monitoring in children with traumatic wounds should be strengthened and antibiotics should be selected rationally to reduce the production of multidrug resistance of pseudomonas aeruginosa.

Pediatric surgery is the important part of the paediatrics,and the complicated content,limited time and many difficulties are the main problems of pediatric surgery teaching.The bed side teaching is the supplement for the class teaching,which could solve those problems.Multi-media technique is used in bed side teaching of Pediatric surgery,which is convenient for preparing lesson and teaching of teachers and review and summary of students.After the technique is used,the teaching efficiency and the quality are obviously improved.

Clinical practice is an important period to train student's skills in pediatric surgical learning,but it is confronted with difficult condition under the new doctor-patient relationship.How to resolve these difficulties is the key to carry on teaching successfully.Aaccording to the students' interests and the knowledge structure characteristics,teachers should cultivate their professionalism,train their communication skills,extend their thinking ability with appropriate use of teaching aid to increase the teaching interests and develop self-learning ability.

Many pediatric surgeons have little training in laparoscopic application.The major problem in clinical practice of laparoscopic technician is without regularly training,unsuitable indication,and ignoring peroperation management.so that there are much more serious complications.For these reasons,it is a prerequisite that surgon and anesthetist must be trained before clinical practice,and the qualification of admission should be strictly controlled.

Pediatric surgery is the important part of the paediatrics,and the complicated content,limited time and many difficulties are the main problems of pediatric surgery teaching. The multimedia courseware is used in teaching of pediatric surgery,which is convenient for teachers'preparing lessons and teaching and is beneficial to students'review and summary. After the technique is used,the teaching efficiency and the quality are obviously improved.

Multimedia is a widely-used teaching means in contemporary medical education.Establishing and improving the multimedia teaching material library is a strong guarantee for the smooth implementation of multimedia.The causes,significance and methods for establishment of pediatric surgery teaching multimedia material library according to the characteristics of pediatric surgery teaching are described in this article,with a view to provide a reference to other relevant professional institutions.

ObjectiveTo assess the diagnosis and treatment of staphylococcal scalded skin syndrome (SSSS)in children.MethodsA total of 177 children whh SSSS were eligible for this study.Clinical data were retrospectively reviewed to assess the patients' age and geographical areas,predisposing factors,prodrome,clinical features,results of laboratory examination(including bacterial isolation and drug susceptibility test),treatment and prognosis.ResultsThe median age at onset was 23 days past 15 months.Infants aged 1 to 3 years were the most commonly affected population.The male to female ratio was 8:9.SSSS occurred in summer or autumn in 71.2％ of the patients.Most patients came from countryside.Of these patients,148 (83.6％) had no definite inducement,13 (7.3％) had fever or cold history before the occurrence of SSSS.Skin lesions often began in the face(71.6％).Almost all cases presented with erythema and blisters.Abnormal myocardial enzymes were observed in 104(80.6％) of 129 patients,and Staphylococcus aureus was isolated from 38.7％ of 142 patients.Susceptibility testing of 21 Staphylococcus aureus isolates from patients in the past 3 years showed that 95.2％ and 95.0％ were sensitive to cephalosporins and amoxicillin/clavulanic acid respectively.Double-antibiotic therapy was effective in 72.9％ of the patients.Intravenous gamma globulin was given to 36.2％ of the patients in the early stage.Myocardial-protecting drugs were also administrated early in patients with abnormal myocardial enzymes.All the patients healed without scarring.ConclusionsFor infants with acute facial erythema and exfoliative skin lesions,SSSS should be suspected and timely antibiotic treatment should be given.Cephalosporins and semi-synthetic penicillins are effective and the first choice for the treatment of SSSS.Meanwhile,early addition of gamma globulin and myocardial-protecting drugs may be beneficial to disease recovery.

BACKGROUND:In recent years, tissue engineering has made great progress, and skin tissue engineering is especialy noteworthy. Artificial dermis (PELNAC) is relatively used widely, but there is a lack of relevant reports on wound repair in children. OBJECTIVE:To investigate the clinical efficacy of Pelnac? METHODS:In a retrospective study, 22 patients with the wound of severe trauma were treated with Pelnac as skin graft dressings on treatment of the wounds of severe trauma in children. ? graft, negative-pressure wound therapy and split-thickness skin graft as experimental group (Pelnac? group), and another 19 patients treated with granulation formation dressing and split-thickness skin graft as control group. We colected data including the graft livability, the required re-operative times and the epithelization time after the skin graft. During the folow-up, the skin color and texture of survival skin, subcutaneous fulness, scar hyperplasia and the joint function were also evaluated. RESULTS AND CONCLUSION: In the Pelnac ? group, the graft livability was up to 90% within 10-14 days after grafting. The secondary split-thickness skin graft was required in two cases in the Pelnac? group and in eight cases in the control group. There was a significant difference in the graft livability (P < 0.05). The average epithelization time after the skin graft was (13.86±3.09) days in the Pelnac? group, which was significant shorter than the control group, (19.10±4.62) days, after the first time operation (P< 0.05). During the 10 months folow-up, the survival skin color and skin elasticity in the Pelnac? group was significantly better than that in the control group (P< 0.05). Better subcutaneous fulness and milder scar hyperplasy in the injured sites were obtained in the Pelnac? group compared with the control gorup. Five cases had certain joint function limitation in the Pelnac? group, compared to 10 cases in the control group, with a significant difference (P < 0.05). Artificial dermis Pelnac? has a stronger anti-infectious ability and higher graft livability. Pelnac? graft combined with negative-pressure wound therapy, granulation culture and split-thickness skin graft can shorten the epithelization time, improve wound healing and aleviate harm to the joint function after the skin graft.