Objective To evaluate the feasibility of application of preoperative acute hypervolemic hemodilution (AHH) to the patient with carcinoma during major surgery Methods Forty ASA Ⅰ Ⅱ patients scheduled for resection of esophagus or cardia cardinoma were randomized to two groups: in AHH group with the routine infusion of lactated Ringer's solution, Gelofusine solution 15ml/kg was infused intravenously at a rate of 80 ml/min immediately before incision under isoflurane inhalation anesthesia, and in control group only lactated Ringer's solution was administered routinly under isoflurane inhalation anesthesia In both groups, MAP, HR, CVP,SpO 2 and P ET CO 2 were monitored during the whole anesthetic procedures; Hb, Hct, Pt and Aptt were measured before and after the hemodilution, at the end of operation, 24h and 1 week after operation; The volume of infusion, blood loss and blood transfusion were recorded during the operation Results Following hemodilution in AHH group , CVP increased markedly (P0 05); the required volume of lactated Ringer's solution and blood loss remained unchanged significantly,but transfusion volume reduced significantly in AHH groups (P

Objective To investigate the method and effect of free autogenous palmaris longus tendon transplantation in the treatment of moderate and severe cicatricial ectropion.Methods The autogenous palmaris longus tendon was obtained through a small lateral proximal wrist band incision (lengths from 4 cm to 6 cm).The graft was properly sutured to the exposed tarsus and the attachments of inner and outer canthus.Local skin flap was rotated to cover the tendon and to repair the wound.Results Six man (8 eyes) with moderate and severe cicatricial ectropion were treated in our department,all case of ectropion were rectified after operation.The eyeballs were well contacted with lower eyelid and no recurrence of eetropion,epiphora and corneal exposure during 6 to 18 months' follow-up.The tension of the lower eyelid was abiding with satisfied effects.Conclusions The palmaris longus tendon is easy to obtain and there is no harm to the donor site.The cicatricial ectropion could be repaired with self-palmaris longus tendon transplantation with lasting effect and the recurrence rate is lower,which is well worthy popularizing.

Objective To investigate the effect of superomedial pedicle mammaplasty in the treatment of the deformity of hypermastia,and secondary deformity after implants or polyacryamide hydrogel removal.Methods Thirty-six patients underwent a new technique for mammaplasty.This technique involved a superomedial pedicle with or without Würinger's horizontal septum which was used to repair the deformity of hypermastia,and secondary deformity after implants or polyacryamide hydrogel removed.Results In our series,the new nipple-to-sternal-notch distance was (20.10±1.94) cm postoperatively.Mean nipple elevation was 7.5 cm (range 4 13 cm),and there were no he matoma and partial or complete nipple-areolar complex (NAC) necrosis occurred.Minimal wound dehiscence occurred in two cases (5.56 ％),the rest cases were healed in stage Ⅰ.Twenty eight patients were followed up for 6 to 18 months.NAC sensibilities were comparable before and after operation,and good breast shapes were produced with unconspicuous incision scar in all cases.Conclusions Superomedial pedicle mammaplasty could achieve satisfactory results with respect to breast contouring and scar,meanwhile maintain the NAC viability and sensibility.

Objective To explore the strategy of repairing penile defect after necrosis caused by shortwave diathermy.Methods Between January 2004 and June 2012,18 cases with penile defect after necrosis caused by shortwave diathermy were admitted in our hospital.The age of those patients ranged from 18 to 55 years old (mean 34 years old).Among them,15 cases have been married.All patients have the history of penile shortwave diathermy therapy after surgery.After debridement,penile complete defect was found in 6 cases,incomplete defect was found in 10 cases and corpus cavernosum and corpus spongiosum partly defect was found in 2 cases.Under general anesthesia,we applied penis extent in 10 cases with incomplete defect,forearm free flap in 2 cases with penile complete defect,abdominal artery perforators flap in other 4 cases with penile complete defect.In 2 cases with corpus cavernosum and corpus spongiosum partly defect,the scrotal septal skin flap and fascia pedicle flap was used for 1-stage urethral reconstruction and costicartilage was implanted for 2-stage cavernosum reconstruction.Results 18 patients were followed up for 0.5-10.0 years (mean 2.3 years).16 cases with penile complete defect or incomplete defect had normal length after operation,ranged from 6.3 to 9.2cm.During erectile phase,the length of their penis ranged from 8.7 to 11.5 cm.No feeling abnormality or erectile dysfunction was complained.All patients exhibited the excellent morphology and felling of penis with minor scar in donor site.Early (half a month) complications included distant flap necrosis in 1 case and disruption of the wound in 1 case,which were cured after debridement and conventional treatment.After one year,we did not see the flap atrophy.One case had tumid which influenced penile beautiful and sexual intercourse.It was improved by local liposuction.One month after surgery,two patients with corpora cavernosa and corpus spongiosum partial defect had normal voiding.No feeling and erectile dysfunction were complained during the following-up.Conclusions According to the characteristics of the penile defect due to the shortwave diathermy,selecting the optimal skin flap and individual repair strategy are the keys to successful treatment.

Objective To discuss the reasons of iatrogenic nipple-areola necrosis and to investigate clinical effect of nipple-areola reconstruction by three-bladed flap combined with free skin graft.Methods Between May 2012 and May 2015,13 patients with nipple-areola necrosis caused by iatrogenic reasons were treated with our new method.We designed a skate flap on the new nipple site.After incising skin,three-bladed flap was cross-stitched to form a new nipple.New areola was reconstructed by free skin graft,which was obtained from perineum or contralateral areola,and margin of the donor area was sutured after proper free from surrounding tissues.Being deducted subcutaneous tissue,the full-thickness skin graft was sutured around the nipple just like letter O.After operation,the areola area was pressurized bandaging,and the nipple was drawn by silk at least one month.Results The incisions were all primary healing.Over a mean period of 8 months (range 6-18),all patients were satisfied with the results.No significant asymmetry occured.The average nipple retraction rate was 10.03％.In 13 patients,there was no infection,bleeding or hematoma and skin flap necrosis.Conclusions Nipple-areola necrosis occurs when the blood supply is not protected carefully during a breast plastic surgery.Therefore,we take full advantage of the scar tissue which has hyperpigmentation.Reconstructive nipple-areola complex has good shape,and there is no need to tattoo after operation.

BACKGROUND:Interleukin-1 receptor-associated kinase 4 activity-induced inflammations and infection have been extensively accepted. However, there was no report concerning its effects on flap ischemia-reperfusion injury. OBJECTIVE:To explore the significance of interleukin-1 receptor-associated kinase 4 activity in flap ischemia-reperfusion injury. METHODS:A total of 36 adult male Sprague-Dawley rats were randomized into sham-operated group (n=12), ischemia-reperfusion group (n=12) and interleukin-1 receptor-associated kinase 4 group (n=12). The models of right lower abdominal island flap ischemia-reperfusion injury were set up. Interleukin-1 receptor-associated kinase 4 group was intraperitoneal y injected with 1 mL of interleukin-1 receptor-associated kinase 4 (100μmol/L) before reperfusion. The flaps were col ected at 1, 2, 4, and 6 hours after ischemia-reperfusion injury for histopathhological observation. At 1 hour after ischemia-reperfusion, protein expression of interleukin-1 receptor-associated kinase 4 was detected in flaps. The proportion of flap survival was calculated at 7 days after surgery.RESULTS AND CONCLUSION:Histopathological observation demonstrated that compared with the ischemia-reperfusion injury group, neutrophil infiltration and edema was evidently improved, and the protein expression of interleukin-1 receptor-associated kinase 4 was gradual y reduced in the interleukin-1 receptor-associated kinase 4 group. Flap survival proportions were respectively (51.70 ±7.62)%and (86.56±12.23)%in the ischemia-reperfusion injury group and interleukin-1 receptor-associated kinase 4 group at 7 days after surgery. There were significant differences in the flap survival proportion between the two groups (P<0.01). These results showed that after flap ischemia-reperfusion injury, the inhibition of interleukin-1 receptor-associated kinase 4 activities could elevate the survival rate of transplanted flap.

A serious complication of penile girth enhancement with acellular dermal matrix(ADM) patch is large area penile skin necrosis. Since the penile skin has characteristics such as thin, elasticity, pliability, and durability to withstand erection and friction, the repair surgery is often difficult to achieve good results. Furthermore, the implantation of ADM patch increases the difficulty of surgery. From March 2014 to August 2019, a total of 13 patients with skin necrosis after penile girth enhancement with ADM patch were treated in our center.The debridement and change dressing, according to the condition of the necrotic skin of penis, were performed in all patients. 7 patients used the repairing method of scrotal skin flap via one side scrotal artery, 6 patients used the repairing method of full thickness skin graft. The penile function was not affected with 6 to 12 months′ follow-up after surgery and the curative effect was satisfactory.

OBJECTIVETo regain bile excretory function of hepatocytes cultured in vitro.

METHODSSandwich configuration was used to culture hepatocytes and the structure of bile canaliculi as well as the function of bile excretion was observed by immunocytochemistry and the test of FDA metabolism with a single collagen configuration as a control.

RESULTSFirst, the formation of bile canaliculi was observed by immunocytochemistry. In sandwiched hepatocytes, the gradual development of bile canaliculi-like structures into an anastomotic network was observed. At 24 h after cell culture, the formation of bile canaliculi was observed. With time progressed, the bile canaliculi became more clear and the network was established at 120 h. In contrast, hepatocytes in single collagen configuration showed almost no network of bile canaliculi. Second, the ability for hepatocytes to internalize, metabolize and excrete compounds into bile was indicated by FDA metabolized in the hepatocytes. In sandwiched hepatocytes, the bile excretory function was shown at 96 h, but in single collagen system, no bile excretion was observed.

CONCLUSIONCultured hepatocytes are able to regain bile excretion in a given certain condition. Sandwich-cultured hepatocytes can reestablish bile canalicular structure and regain bile excretory function.

Animals ; Bile ; secretion ; Bile Canaliculi ; physiology ; Cells, Cultured ; Female ; Hepatocytes ; secretion ; Immunohistochemistry ; Rats ; Rats, Sprague-Dawley

Objective To investigate the effect of superomedial pedicle reduction mammaplasty in the treatment of severe gynecomastia.Methods 24 males with severe gynecomastia were involved in this study,who underwent superomedial pedicle reduction mammaplasty.Results All the patients were followed up for one to two years,and there were no complications such as skin necrosis,nippleareolar complex (N A C) hypaesthesia,hematoma or infection occurred.Minimal wound dehiscence occurred in two cases,and the rest cases were healed well.Conclusions Superomedial pedicle reduction mammaplasty in the treatment of severe gynecomastia could achieve satisfactory results,and good breast shapes are produced.

Objective:To investigate the clinical effect of platelet rich plasma combined with autologous fat free grafting in penile enlargement.Methods:From February 2015 to April 2016, In our department, 18 patients (aged 21-42 years, average 30.5 years) underwent penile thickening. Platelet rich plasma was prepared from peripheral venous blood, Then liposuction in the thigh root to obtain autologous fat and purification, Platelet rich plasma combined with autologous fat mixture with 1∶3 ratio, then injected between the superficial fascia and deep fascia of penile.Results:18 patients Were followed up for 6 to 12 months postoperatively, The penile circumference increased by 2.80 cm average, patients were satisfied with the appearance of the penis, No complications occured such as infection and fat liquefaction, less fat absorption, of which 10 cases were married sex life satisfactory.Conclusions:Platelet rich plasma combined with autologous fat free grafting penile enlargement contributes to the survival of grafting fat and reduces fat absorption. The penis appearance is fine with satisfactory effect.