Objective To study the effect of dexamethasone to protect flaps from an ischemia-reperfusion injury and elucidate its mechanism of regulating the death course of the neutrophils. Methods The rats were randomly divided into 3 groups.The vein of the rat was clamped for 8 h after the flap had formed. Group A: the normal flap; Group B: the saline control flap; Group C: the treatment flap with dexamethasone. The survival area of the flaps was measured at 7 days; the apoptotic and necrotic neutrophils,tumor necrosis factor α (TNF-α), and interleukin 10 (IL-10) concentrations were measured. Results The flap survival are as in Groups A and C were larger than those in Group B. The apoptotic neutrophils in Group B were fewer than those in Groups A and C on the 1st and 3rd days after operation; however, they were more in number in Group B than in groups A and C on the 6th day. The necrotic cells in Group B were more in number than those in Groups A and C. In Group B, the plasma TNF-α concentration reached the maximum level at 1 h,while the IL-10 level reached the lowest 3 h after the reperfusion. In Group C, the TNF-α concentration was lower than that in Group B and decreased dramatically at 6 h. The IL-10 concentration was the lowest at 1 h, and increased rapidly at 3 h.Thus,ischemia-reperfusion could injure the flaps, probably through the abnormal action of the neutrophils, such as the disordered secretion of the cytokines and abnormal death course of the neutrophils. Conclusion Dexamethasone can protect the flap from an ischemia-reperfusion injury by its regulation for the neutrophil function.

Objective To explore a new method for reconstruction o f full-thickness defect of eyelid. Methods The composed skin flap which was lined the expanded forehead skin flap with oral mucosa were transferr ed to the defect of eyelid and then sutured anatomically to the eyelid skin. Fou r months later, the composed flap was divided to reconstruct upper and lower eye lids and put an artificial eye into it. Results The appearance and function of the eyelid was partly recovered. Conclusion The reconstruction of full-thickness eyelid defect with expanded and prefabricated skin flap with grafted mucosal liner is better and reliable.

Objective To observe the changes of synaptosome membrane fluidity and intrasynaptosome free calcium in ovariectomized rats' brain and the therapeutical effects of genistein. Methods Thirty-six 3 month-old female Sprague-Dawley rats were randomly assigned to 4 groups:sham-operated,ovariectomized control,genistein and estradiol benzoate groups.Normal saline(50??l),normal saline(50??l),genistein(250??g)and estradiol benzoate (50??g)were subcutaneously injected respectively once every other day for 8 weeks,and then synaptosome membrane fluidity and intrasynaptosome free calcium in frontal and parietal lobe and hippocampus were detected. Results The intrasynaptosome free calcium of cerebral cortex and hippocampus synaptosomes of ovariectomized control group (?s)are (243.31?31.21)nmol/L and (305.10?54.31)nmol/L respectively.There are significantly statistical differences as compared ovariectomized control group with sham-operated,genistein and estradiol benzoate groups(P0.05).The synaptosome membrane viscosity(?)of hippocampal synaptosomes of ovariectomized control group(?s)is 3.03?0.39,which has significantly statistical differences compared with sham-operated and estradiol benzoate groups(P0.05).Conclusion The synaptosome membrane fluidity decreased while intrasynaptosome free calcium increased in ovariectomized rats' synaptosomes.Genistein can enhance the membrane fluidity and maintain intrasynaptosome free calcium in ovariectomized rats' synaptosomes.

Objective　To study the role of TNFα in the plasm a and skin and IL-1 in the serum in the formation of secondary thrombosis after skin avulsion. Methods　After avulsive flap at size of 12 cm×4 cm was inflicted on the hind legs of pigs, skin specimens and venous blood sam ples were taken at various time points. The contents of TNFα in plasma and skin were determined with radio-immunoassay, and the activity of serum IL-1 wi th 3［H］-TdR. Results　The TNFα contents in the plasma and skin were increased significantly after avulsion（P<0.01），which were (41 5±24) ng/L and (298±18.5) ng/L respectively on the 3rd day after the injury. T he activity of IL-1 in the serum was increased (P<0.05) and was (2.59± 0.85 ) ng/L on day 3. Conclusion　The changes of TNFα contents and I L-1 activity in blood and skin play important roles in the inducetion and aggra vation of secondary tissue necrosis and early thrombosis after skin avulsion.

Objective To investigate the cosmetic outcome of treatments for mentalis scars with expanded skin flaps.Methods From the experiences of past 26 cases in our department,we summarised the technique for treating the mentalis scars with expanded skin flaps.For simple mentalis scars or localized inferior facial scars,the mentalis,bottom jaw or facial skin were expanded and the expander kept superior to the neck-jaw angle.Otherwise the expander would only fill the angle and the expanding efficiency was reduced.For severe mentalis,neck or facial scars without extra normal treating skin,expanded deltopectoral flaps were chosen to cover the wound after cicatrectomy with pedicles which were cut 3 weeks later.Results All the local ordistant expanded flaps survived successfully in the 26 cases with optimistic outcomes.Conclusions Application of local or distant expanded flaps is a useful technique for mentalis scars treatment.

Objective To explore the aesthetic effect of the applying the expanded skin flap to re-pair facial defects produced by removal of nevus, hemangioma, scars and so on. Methods The experience of the treating 67 patients with facial lesions using the expanded flaps were reviewed. The proper expand-ers were chosen according to the scope of the facial lesion. The incision was located at the scar region and the dissection was executed in the superficial layer of the SMAS. The interspace was larger than the ex-pander by 1.0～1.5 cm. After exact hemostasis, the expanders and negative pressure drainage tubes were placed into the interspace. The design of the facial expanded skin flap included the advance, rotation, and transposition of skin flap and so on. The advance of skin flap took fully use of the expanded skin flap without the donor site defect. The transposition of skin flap also took fully use of the expanded skin flap, furthermore, it overcame the displacement and the disfiguration caused by the applying of the advance skin flap and rotation skin flap. The incisions in face were designed to a minimal extent and parallel to the Lan-ger line. Results All of the 67 cases got aesthetic satisfied results with all the flaps surviving. Conclusion The application of expanded skin flaps is proved to be an effective way of repairing facial wound when there is enough normal facial skin for expansion.

Objective To develop new repairing techniques for acquired inferior palpebral region defects. Methods Expanded forehead flaps were used to reconstruct the inferior palpebral defects or post-excision wound surface and the flaps were pedicled with supra-trochlea vessels or ramus frontalis arteriae temporalis superficialis. As for supra-trochlea vessels, contralateral ones were prior to the homolateral ones. The incision site located in the scalp and the major axis of the expander parallel to the forehead. Firstly, the leisions were cut and the subcutaneous tissues loosed to regain the anatomy position of inferior palpebra. Secondly, the expanded flaps were transfered onto the defects by the wound sizes with the supra-trochlea vessels as their pedicles. At last, the pedicles were cut 3 weeks later.For ramus frontalis arteriae temporalis superficialis, the flap was transfered with a subdermal pedicle and the donor site was closed directly. Results There were 10 cases in the present group, 6 for supratrochlea vessels and the 4 others for ramus frontalis arteriae temporalis superficialis. All the flaps survived successfully. 3 cases returned with optimistic outcomes 6 months later. Conclusion The expanded forehead flaps are fit for repairing the inferior palpebral defects, which can successfully avoid ectropion. This technique is very useful for reconstructing the texture of the site of defects.

Objective To investigate the influence of gene transfection antiangiogenesis on microvessel and relative cytokine of hypertrophic scar of rabbits' ear.Methods The hypertrophic scar of rabbtis' ear was reproduced.On the 10th day after epithelization,Ad-METH-1 was injected into tissue of scar.30 days later,the microvessel of scar-tissue was detected by microcirculation microscope.Meanwhile.H&E and immunohistochemical stains were performed.Then the results were analyzed.Results 30 days after Ad-METH-1 injection.in experimental groups,the microvascular count of scar tissue was 12.38±2.56,the percentage of VEGF positive cells was 17.64%,and the percentage of bFGF positive cell was 18.24%:while in the control groups,the microvascular count of scar tissue was 48.12±6.46.the percentage of VEGF positive cell was 31.34%.and the percentage of bFGF positive eell was 28.26%.Results revealed that the count of microvessel of scar tissue in the experimental groups was lower than that in the control groups,between which there was the difference in statistics(P＜0.01).and that the percentage of VEGF and bFGF positive cells of scar tissue in the expenmental groups were lower than that in the control groups.between which there was the difference in statistics(P＜0.05).Conclusion Ad-METH-1 has marked inhibitory effects on scar tissue hyperplasia of rabbits' ear,angiogenesis and expression of VEGF and bFGF.Using antiangiogenesis therapy at the early phase could inhibit the formation of hypertrophic scar.Gene transfection antiangiogenesis therapy could bid fair to become an effective method to prevent and treat hypertrophic scar.

With the development of specialization and specialist differentiation of modem medicine,the developing mode of "reducing and specializing" has promoted the explosive growth of medical knowledge.Meanwhile,the medical practice based on medical knowledge is being fragmented,and medical activities are gradually moving away from the'people-oriented'core value.Therefore,current medical modality needs to be transformed into a "holistic medicine" stage,which also requires reforms of medical personnel cultivation,including the emphasizes of holistic view as well as multidisciplinary integration.Medical schools are exploring paths to achieve holistic medicine-oriented education and training of students.Currently,the concept of holistic medicine have begun to permeate in medical curriculum design and teaching method innovationand yet needs to befurther deepened in understanding and practicing the essence of the holistic medical modality in the future.

Objective To explore the technique of massive facial scar revision. Methods All 12 patients in the group were treated with expanded deltopectoral skin flap. In the primary surgery, expander was implanted underneath deltopectoral flap region through an incision inferior to the clavi-cle. The skin perforators of transverse cervical artery and thoracoacromial artery were ligated during surgery, and the internal thoracic artery was carefully preserved. After the deltopectoral skin flap was fully expanded, the second surgery was performed and the facial scar was released and the normal ana-tomic position of eyes, nose and month was restored. The deltopectoral skin flap was planed according to the size of the defect. The excised facial scar was converted to the flap pedicle and a hinge-like con-nection was formed. The flap was delayed and three weeks after the second surgery, the pedicle was divided. The flap from the pedicle was applied for the mental region scar revision. Results Unilateral or bilateral dehopectoral skin flaps were employed for the repair of extensive facial scar in 12 patients. Satisfactory results were achieved in all these patients. Conclusion Expanded deltopectoral skin flap is a good technique for the repair of extensive facial scar.