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.

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.

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.

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.

OBJECTIVETo explore the role of histone H3 acetylation in cleft palate induced by 2, 3, 7, 8-Tetrachlorodibenzo-p-dioxin (TCDD) in C57BL/6J mice, and its mechanism.

METHODSOn gestation day 10 (GD10), 36 pregnant mice were randomly divided into two groups as the treated group(n = 18) and the control group( n = 18). The mice in the treated group received intragastric administration with TCDD 28 μg/kg, while the mice in the control group received equivalent corn oil. The pregnant mice were sacrificed on GD13. 5, GD14. 5 and GD15. 5, collecting fetal palates to determine the activities of histone acetyltransferases (HATs) by Colorimetric and the expression level of acetylated histone H3 (Acetylated histone H3, Ac-H3) by Western-blot.

RESULTSThe activity of HATs was 0.409 7 ± 0.0147, 0.522 3 ± 0.017 1 and 0.643 5 ± 0.013 9 in control group on GD13.5, GD14.5 and GD15.5; 0.865 0 ± 0.0129, 0.719 1 ± 0.017 8 and 0.551 2 ± 0.016 8 in TCDD group. The activity of HATs in TCDD group was higher than that in control group on GD13. 5, GD14. 5, showing significantly difference between the two groups (t = - 56. 932, t = - 19. 516, P < 0.01); however, the activity of HATs in TCDD group was significantly lower than that in control group on GD15. 5 (t = 10. 382, P < 0.01). The expression level of Ac-H3 was 0.745 0 ± 0.113 5, 1.055 9 ± 0.249 4 and 1.795 5 ± 0.081 9 in control group on GD13. 5, GD14. 5 and GD15. 5; while 1.4490 ± 0. 1460, 1. 641 8 ± 0.099 7 and 1. 512 1 ± 0. 150 2 in TCDD group. The expression of Ac-H3 in TCDD group was higher than that in control group on GD13. 5, GD14. 5, showing significantly difference( t = -6. 593, -3. 779, P <0. 01, P <0.05) ; However, the expression of Ac-H3 in TCDD group was statistically lower than that in control group (t = 2. 870, P <0. 05).

CONCLUSIONThe acetylation of histone H3 was involved in the cleft palate of C57BL/6J mice induced by TCDD, which may be one of the mechanisms in TCDD-induced cleft palate.

Acetylation ; drug effects ; Acetyltransferases ; metabolism ; Animals ; Cleft Palate ; chemically induced ; metabolism ; Dioxins ; Female ; Fetus ; Histones ; metabolism ; Humans ; Mice ; Mice, Inbred C57BL ; Polychlorinated Dibenzodioxins ; Pregnancy ; Random Allocation ; Teratogens

OBJECTIVETo explore the clinical effect of using dorsal two wing-shaped flap to reconstruct finger web for treatment of congenital syndactyly.

METHODSThis technique has been used in 19 children with congenital syndactyly. At the dorsum, a flap with V-shaped tip and two wing-shaped pedicle were designed and was just sewed up with an anchor-shaped incision at the palm. The web was primarily reconstructed without skin graft at base of fingers. Distal end of fingers were separated by using serrated flap and were closed after removal of fatty tissue. At some cases with tight skin connection. The defect area at lateral and distal end of fingers was closed by small pieces of skin graft.

RESULTSAll the webs were reconstructed primarily without skin graft at the base of fingers. 7 cases with tight skin connection had small pieces of skin graft at lateral and distal end of fingers. Primary healing was achieved in all cases. After 1 to 6 months of follow-up, both the appearance and function were satisfactory without conspicuous scar. The reconstructed finger webs were in normal depth and width.

CONCLUSIONSPrimary web space can be achieved by dorsal two wing-shaped flap without skin graft at base of fingers. It is one of the best choices for treatment of congenital syndactyly.

Adipose Tissue ; surgery ; Child ; Cicatrix ; Dermatologic Surgical Procedures ; methods ; Fingers ; surgery ; Humans ; Skin Transplantation ; Surgical Flaps ; transplantation ; Syndactyly ; surgery ; Wound Healing

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.