BACKGROUND: There are many advantages in treatment of deglovinginjury in hand with compatible grafting of temporoparietal fascial flaps(TFFs), while there are few relevant reports in China.OBJECTIVE: To evaluate function and appearance of hands after restora-tion of soft tissue defects with compatible grafting of TFFs.DESIGN: Case retrospective analysis.SETTING: Department of Maxillofacial Surgery, Plastic Surgery Hospital,Peking Union Medical College, Chinese Academy of Medical Sciences.PARTICIPANTS: Eleven patients with hand injuries received compatiblegrafting of TFFs in the Department of Maxillofacial Surgery of PlasticSurgery Hospital, Peking Union Medical College, Chinese Academy ofMedical Sciences from January 2001 to May 2005 were selected including8 males and 3 females with a mean age of 30 years. All subjects participat-ed in the observation and analysis voluntarily. All patients presented expo-sures of tendon, bone or joint.METHODS: Preoperative location was done with Doppler or palpation methods and the orientation of temporal vascular nerve tracts were labelled. Re-cutization of surface of fascial flap was achieved through fullthickness skin transplantation. Sizes of fascial flaps were limited between 10 cm×9 cm and 4 cm×6 cm. Follow-up was 8 months (6-11 months),the items of which included postoperative functional inspection and satisfactory degree of appearance. Ratio of total active range of motion (AROM) with joints injured and corresponding uninjured joints were used for functional evaluation, and the meso was zero. Functional rehabilitation was divided into 3 grades according to the ratio: Good as the ratio above 0.75, fair as the ratio between 0.5 and 0.75, poor as the ratio below 0.5. Evaluation on appearances of hands contained satifactions of both patients and doctor including whether there were fat and clumsy or visible scars.MAIN OUTCOME MEASURES: Postoperative functional recovery of hand after compatible grafting of TFFs.RESULTS: Eleven patients with hand injury were included and 4 patients withdrew from the study. ①Fascial flaps of 9 patients completely survived,one patient got partial necrosis due to venous injury during flap harvesting,and wounds spontaneously healed by exchanging dressing. Venous crisis was found in the 3rd day of postoperation in one patient during operation research (OR) and there were thromboses in anastomosed veins due to the folding of overlong vein, which was unobstructed after reanastomosis, while there were sporadical scars in the raw surfaces. ②Functional recovery of hands were good in 4 cases and better in 3 cases, 4 cases withdrew from the study. Both doctors and patients were satisfied with the recovery status of appearance of hands.CONCLUSION: It is better to simultaneously adapt compatible grafting of TFFs and re-cutization in restoration of tissue defects in hands such as exposures of bone and tendon. Better aesthetic results can be achieved with out second flap restoration. Most of all, the supple texture of fascial tissues provides a good gliding environment for functional recovery of tendon and joint, moreover, scars in donor sites are well camouflaged without functional lesions.

Objective To study the operation design and surgical methods for terminal surgical reconstruction of severe post-midfacial fracture deformities. Methods From July 1997 to December 2002,11 cases of severe and complex post-midfacial deformities were reconstructed. There were four cases with Le Fort Ⅰ, Ⅱ and Ⅲ fractures,five with Le Fort Ⅰ and Ⅲ fractures and two with Le Fort Ⅰ and Ⅱ fractures combined with right orbital-zygomatic fractures. Typical bicoronal and subcilliary incisions and intra-oral approach were employed to expose all the fractured sites. The displaced orbito-zygomatic bone fragments were repositioned firstly in order to reconstruct the outer midfacial framework. Then, the malunited maxilla was reduced to its proper position after osteotomy of Le Fort Ⅰ fractures under the guidance of mandible through inter-maxilla fixation. The depressed naso-orbital region were reconstructed using autogeneous outer cranial table. Meanwhile, nasal framework reconstruction, medial canthal tendon reapproximation and plasty, and fractured orbital walls repairing were performed to correct the enophathalmos. Results All the cases recovered well and the post-operative facial appearance and occlusal function were improved obviously. Conclusions Complex midfacial fractures, usually involving orbital-zygomatic bone, naso-orbit and maxillary bone, can be well improved through osteotomy and reduction, internal rigid fixation with mini-plates and screws, autogenenous bone grafting and framework reconstruction.

Objective To introduce a new method for correcting square face deformity.Methods This operation consists of malar reduction (MR)and mandibular angle osteotomy (MAO),which could be done simutaneously or at different time.Results A total of 21 patients with square face deformity accepted MR and MAO in which 12 cases were done simutaneously and 9 cases at different time.After this procedure, the width of the mid face and the lower face reduced by 15.3?3.2mm and 14.2?2.5mm, respectively. A11 the cases achieved satisfactory results without complications.Conclusion This method can effectively correct square face deformity by reducing the width and protrusion of the mid face and the width of the lower face.

Objective To investigate the changes of the constitution and its ratio of collagen fiber in the process of masseter reattachment following different osteotomies of the prominent mandibular angle so as to offer guidance for the resection of mandibular angle. Methods Sixteen adult goats were randomized into four groups. In group A we performed unilateral curved osteotomy of the mandibular angle. In group B unilateral curved ostectomy was performed with partial masseter resection. In group C unilateral angle splitting ostectomy, while in group D unilateral dissection of the masseter muscle was conducted. The constitution and its ratio of collagen fiber in the interface were observed at 1-month, 2-month, 3-month, and 6-month after operation. Results On the changes of collagen fiber in the process of muscular reattachment, at 1-month post-operation, the constitution of collagen fiber (types Ⅰ and Ⅲ) in groups A and B were significantly different from that of control group (P<0.05). However, both groups C and D had no statistic difference from control group (P>0.05). At 2-month, 3-month and 6-month post-operation, those of all experimental groups had no statistic difference from control group. And with time, the percentage of collagen fiber type Ⅰ increased and type Ⅲ decreased gradually. Conclusion The recovery sequences of masseter muscle reattachment in this study are firstly group C, secondly group A and finally group B. It suggests that the recoveries of mastication and other oral activities are different. Group B turns out to be with a slow muscle reattachment. Thus, we recommend treating different kinds of mandibular hypertrophy with different ostectomies.

BACKGROUND: Bone morphogenetic proteins (BMPs) are involved in the formation of various tissues including bone, cartilage, tendon, and ligament. Vascular endothelial growth factor (VEGF) promotes angiogenesis by increasing the permeability and migration of endothelial cells.OBJECTIVE: To construct a co-expressing vector of human bone morphogenetic protein 2 (BMP2) and vascular endothelial growth factor 165 (VEGF165), and observe the expression of BMP2 and VEGF165 in human bone marrow mesenchymal stem cells (hBMSCs).DESIGN: Observation control trail.SETTING: Department of Plastic Surgery, Affiliated Hospital of Luzhou Medical College and Plastic Surgery Hospital of Peking Union Medical College, Chinese Academy of Medical Sciences.MATERIALS: The MSCs derived from the healthy adult volunteers of marrow donors. pIRES-EGFP-hVEGF165 containing total length of cDNA sequence of human VEGF165 gene was provided by Dr. Cheng Ting from Plastic Surgery Hospital of Peking Union Medical College. pSP65-hBMP2 containing total length of cDNA sequence of human BMP2 gene was provided by Dr. Guo Ximin from the Academy of Military Medical Sciences. Enkaryotic expression vector pIRESneo (Clontech Company) Pyrobest DNA Polymerae, restriction enzyme, DNA ligase and plasmid extraction kit, DNA Fragment Purification Kit (TaKaRa Company), LiorfectamineTM liposome transfection kit, DMEM medium, trypase, TRIzoIRNA extraction kit (Gibco BRL), Omniscript RT kit (Qiagen), TaqplusDNA polymerase (Promega), PMSF, leupeptin, aprotinin, chymostatin (Sigma), protease inhibitor, PVDF membrane (Amersham-Pharmacia Biotech), rabbit anti-human BMP2 antibody and VEGF monoclonal antibody (Santa Cruz Company), goat anti-rabbit lgG-peroxydase (Wuhan Boster), G418 (Ameresco Company in U.S).METHODS: The experiment was conducted in the Affiliated Hospital of Luzhou Medical College and the Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences between June 2005 and April 2006.hBMP2 and hVEGF165 cDNA were directional cloned into multiple clone sites of the eukaryotic expression vector pIRESneo. The recombinant plasmid was identified by restrictive enzyme Xho Ⅰ/Bgl Ⅱ digestion analysis and DNA sequencing. Liposome-mediated gene transfer method was used to transfect hBMSCs. For observation, the transfected cells were divided into IRES-hBMP2-VEGF165 group, pIRES-hBMP2 group, pIRES-VEGF165 group and empty vector group, which were transfected with pIRES-hBMP2-VEGF165, pIRES-hBMP2, pIRES-VEGF165 and pIRES-neo. Meanwhile, the same number nontransfected cells were selected as blank control group. The reverse transcription polymerase chain reaction (RT-PCR) and Weszern blot were employed to observe the expression and secretion of hBMP2 and hVEGF165 gene and protein.expression vector hBMP2 and hVEGF165 gene sequence were the same as reported after restrictive enzyme EcoRI and Bgl Ⅱ digestion analysis and pIRES-BMP2 gene sequencing, which showed that the recombinant plasmid pIRES-hBMP2-VEGF165 highly expressed hBMP2-mRNA and VEGF165-mRNA, but the non-transfected or transfected with pIRES-hBMP2-VEGF165 or pIRES-hBMP2 secreted a great quantity of hBMP2, but that non-transfected or transfected with pIRES-VEGF165 or empty vector secreted only little.CONCLUSION: The co-expressing vector of hBMP2 and hVEGF165 can be expressed stably in hBMSCs.

OBJECTIVETo investigate the effect of the anticoagulants on PRP quality, so as to clarify the appropriate anticoagulant used in PRP production.

METHODSThe microstructure change of platelets collected via heparin, citrate, acid citrate dextrose (ACD) and citrate-theophylline-adenosine-dipyridamole ( CTAD) was observed by TEM following time course. The extent of spontaneous activation of platelets in four groups was detected by measuring sP-selectin in plasma. The TGF-β1 release amount of activated PRP of four groups was measured.

RESULTSCTAD is superior to other anticoagulants in maintaining the integrity of platelet structures for a long time and preventing platelet spontaneous activation. ACD slightly surpassed heparin and citrate in above two aspects. ACD-PRP and CTAD-PRP released significantly more TGF-β1 compared with heparin and citrate.

CONCLUSIONSThe PRP quality and biological effects were strongly associated with the type of Anticoagulants. ACD and CTAD are optimal anticoagulants in PRP production for they can maintain platelet viability at a high level.

Adenosine ; pharmacology ; Anticoagulants ; pharmacology ; Blood Platelets ; drug effects ; physiology ; Citrates ; pharmacology ; Citric Acid ; pharmacology ; Dipyridamole ; pharmacology ; Drug Combinations ; Glucose ; analogs & derivatives ; pharmacology ; Heparin ; pharmacology ; Platelet Activation ; drug effects ; Platelet-Rich Plasma ; Theophylline ; pharmacology ; Transforming Growth Factor beta1 ; metabolism

Objective To discuss the way of open reduction and internal fixation for fractured condylar neck and mandible ramus via intraoral approach aiming to avoid the facial incision. Methods Fifteen cases (17 sides) with mandibular condyle fractures underwent open reduction and osteosynthesis with plates and screws. After the mandibular ramus was under vertical osteotomy with an oscillating saw, the posterior border bone block of mandibular ramus as well as the free condyle neck were taken out. The fractured condyle neck and the posterior border bone block of mandibular ramus were fixated with a titanium miniplate in vitro. The reunion bone was implanted and reposited in the mouth incision. Of all, two cases suffered fracture of the condyle neck in the other hospital when they received esthetic surgery and resection of prominent mandible angle (PMA). Results Anatomic reduction was achieved in all cases, without damage to facial nerve and major auricular nerve or salivary fistula. There were slight bony resorption and good temporomandibular joint function one year after surgery, with range of mouth opening for 25-40 mm (mean 35.8 mm). Two cases regained their occlusion before their PMA operation. One case had premature contact of the buccal teeth,with 1 mm diverging to medline of the incisor teeth. Intraoral approach not only could avoid large facial scars and facial nerve injury, but also allow visualization of the occlusion during the procedure. Conclusions As more and more consideration is taken to cosmetology, the transoral approach is a reliable surgical alternative for fractures of the condyle neck, without leaving extensive visible scars or damaging facial nerve. The disadvantage is vertical osteotomy of the posterior border of the mandibular ramus.

This article mainly summarise the results of the chemical compositions and their pharmacological activities of Arnebiae Radix since 1966. The chemistry components isolated from Arnebiae Radix are mainly naphthoquinone, monoterpene phenol and quinone, phenolic acids and their salts, alkaloids, aliphatic and esters. Pharmacological results showed that the chemical compositions and the extracts of Arnebiae Radix have antibacterial, anti-inflammatory, anti-viral, hepatoprotection, antioxidant, anti-tumor and immune function and other activities. This article hopefully to provide a reference for further research, development and utilization of Arnebiae Radix.
Animals ; Boraginaceae ; chemistry ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; Humans ; Molecular Structure ; Plant Roots ; chemistry

OBJECTIVETo investigate the application of three-dimensional CT(3D-CT) in the treatment of oblique facial clefts with mandibular outer cortex, including the surgical design and results assessment.

METHODSFrom Jan. 2003 to Dec. 2013, 22 cases with oblique facial cleft, who underwent mandibular outer cortex onlay bone graft were retrospectively studied. 3D images from CT data were reconstructed before operation for design. Then the mandibular outer cortex onlay bone transplant was performed to reconstruct the bone defect and cleft. 3D CT was performed 5-10 days postoperatively and 6- 12 months postoperatively to assess the facial symmetry.

RESULTSAccording to the results of CT measurement, the average volume of the orbital bone defects on the affected side decreased by(64. 6 ± 14. 4)% 5 to 10 days after operation. The average volume of the maxillary and zygomatic bone defects on the affected side decreased by(71.4 ± 15.7)% after surgery. After 6 to 12 months,the average recovery of the mandibular donor site was (57. 9 ± 13. 9)% of the removed mandibular outer cortex. The average absorption of grafted bones was(24.7 ± 25.6 )%. The average height difference between the centre of pupils on both sides before surgery was(3.76 ± 1.27) mm,which decreased to( 1. 15 ± 1.00) mm 5 to 10 days after surgery(P =0. 000) , and( 1.35 ± 1. 13) mm 6 to 12 months after surgery(P = 0. 003). The relapse may be caused by the absorption of the grafted bones.

CONCLUSIONS3D-CT can be used for preoperative design and postoperative assessment in the treatment of oblique facial cleft with mandibular outer cortex.

Bone Transplantation ; Cleft Palate ; surgery ; Craniofacial Dysostosis ; surgery ; Eye Abnormalities ; surgery ; Facial Bones ; abnormalities ; Humans ; Imaging, Three-Dimensional ; Mandible ; transplantation ; Maxillofacial Abnormalities ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed ; methods ; Transplant Donor Site

Objective High-density porous polyethylene(Medpor)has been widely used in chin augmentation in recent years.The study aimed to observe the outcomes of clinical use of high-density porous polyethylene implant in chin augmentation in contour plastic surgery of low face.Methods From 2005 to 2008,149 cases of chin augmentations intraorally with Medpor implants combined with were collected.121 of them received bilateral mandibular angle osteotomy and 28 cases received bilateral mandibular angle osteotomy and bilateral malar reduction simultaneously.They wre all females aged from 17 to 46 years.The patients were followed up for 6 to 36 months(average 24 months)and photographs were taken before and after operations.Clinical outcomes were observed and analysed.Resuits 145 patients(97.3%)were satisfied with their chin and contour of low face.2 patients (1.3%)were not satisfied with the projection of their chin,and 1 of them were admitted to take out the implant and received sliding advancement genioplasty.1 patient(0.7 0A)felt the implants was too large to some extent and was admitted to modify the implant.1 patient(0.7%)received genioplasty 6months after operation because of the deviation of the implant.20 patients(13.4%)felt numbness of the lower lip which gradually disappeared 1 to 3 months postoperatively.Complications such as infection,edema and extrusion,break of the implant were not found during the following period.Conclusions Medpor is an excellent biomaterial with good biocompatibility.Simultaneously chin augmentation with Medpor combined with bilateral mandibular angle osteotomy intraorally shows a good result in contour plastic surgery of low face.