Objective To understand the status and developmental trends of the research on anterolateral thigh flap. Methods The PubMed search was downloaded and the results were imported into the EndNote database,then the distribution was analysed by age,nation,language,periodical and frequency.Results There were 236 articles on anterolateral thigh flap in PubMed from 1996 to August 2006.The amount of articles multiply increased from 2002 to August 2006,at eighty percent of all.They were published in 8 languages,in 47 journals and from 9 countries.China and the USA are the major countries of the publication,with 77 articles each,which altogether took up 65.2% of the total.Words of a high frequency are as follows: free skip flap,island skin flap,ultrathin skin flap,perforating artery,and descending branch of lateral circumflex femoral artery,the frequency ratio of which is up to 97.46%.Conclusion The papers on anterolateral thigh flap are written mainly by China and USA;English is the main publishing language;The articles are chiefly published by Plast Reconstr Surg and other 8 journals.The research emphases of the anterolateral thigh flap are on free skip flap,perforating flap,ultrathin skin flap,and island flap.Angiography and 3D-reconstruction are the recent techniques for the research.

Objective To explore the arterial origin and the artery distribution to the brachial plexus and its clinical significance. Methods 1)To observe the zonal pattern of arteries supplying brachial plexus in three fresh cadavers by means of modified lead-oxide and gelatin infusion and radiologic development. 2)To observe the arterial origin and distribution under microscope in 10 cadavers embalmed which were injected with red latex from the common carotid artery. Results The brachial plexus was supplied by branches of the subclavian-axillary axis (SAA), and these branches anastomose each other, according to their distribution feature, the supplied neural structures were divided into three zones. The first zone including the nerve roots from intervertebral foramina to the trunks and this region of the brachial plexus were supplied by the vertebral artery and the deep cervical artery. The second zone including the divisions and the main region of the cords of the brachial plexus were supplied by direct branches of the subclavian artery or by branches originating from the dorsal scapular artery. The dorsal scapular artery was usually thick and contributed to blood supply of a large region. There were 2.7 (1-5) direct branches of the subcalvian artery on the average which have relatively smaller diameter. The third zone including the distal portion of the cords and the terminal branches of the brachial plexus were supplied by direct branches of the axillary artery. The mean number of these branches was 3.4 (1-6). Conclusion The brachial plexus has plenty of vascular supply which can be divided into three zones. Every vasa nervorum tends to divide into a distal branch and a proximal branch shortly after they enter the brachial plexus. The branches from vasa nervorum communicates without changing their diameter which is called "real connection", and the blood supplied from the three zones can compensate each other, which provide a rich longitudinal blood supply to the brachial plexus. This study provides an anatomical basis for vascularized brachial plexus replacement.

Objective To provide a new method to repair nonunion or bone defect of femur Methods The descending branch of lateral circumflex femoral artery anastomosis with the lateral superior genicular artery and the branches distribution of the lateral genicular artery were obsereved on 30 sides of adult cadaveric lower limbs The bone (periosteal) flap of the lateral condyle of femur with the pedicle of the descending branch of lateral circumflex femoral artery was designed and appdied in clinical to repair nonunion or defect in the middle or inferior of femur of 13 patiens Results The follow up period was 14～20 weeks All fracture were unionized and union periods were 13～20 weeks, the results were excellent Conclusion The anatomical location of vessels of this bone (periosteal) flap is enduring, the surgery is simply, the transposition is simble, the influence of donor is very small This bone (periosteal) flap adapt to repair nonunion or bone defect in the middle or inferior of femur

ObjectiveTo comprehend the progress of perforator flap research and speculate its developmental trends.MethodsPubMed search was conducted to retrieve the papers published before November,2011.Analyze the literatures about perforator flap on years,nationalities,languages,journals and frequencies of the key words by using Endnote 8.0. ResultsAll 1719 literatures about perforator flap have been collected by PubMed till Oct.31,2011.Lots of them,amount to 51.5 percent,were from USA,China,Japan and UK. ConclusionEnglish was the main publishing language.The articles,which were mainly published by the Plast Reconstr Surg and other 10 journals,add up to 78.7％.The research emphases of the perforator flap will be breast reconstruction, repair defect, deep inferior epigastric artery perforator flap, anterolateral thigh flap,thoracodorsal artery flap,perforator flap of gluteal artery,and posterior leg perforator flap.Angiography and 3D-reconstruction,immunohistochemistry,and neovascularization are the new trend in flap research.

It was bound to think highly of its teaching reform,because our college has in-creased the recruitment of foreign students since 2006.Based on teachers'English level,foreign students'own qualities,discrepancy between teaching mode as well as proper characteristic of preclinical medicine curriculum,the problems were investigated and the corresponding solutions have been sought in the phase of preclinical medicine.

Objective To determine the anatomical basis of an algorithm to safely elevate the deep circumflex iliac artery osteocutaneous perforator(DCIAP) flap. Methods 1.Six unfixed corpses underwent whole body gelatine/lead oxide injection.Specimens were dissected by layers.Angiography and photography were used to document the precise course,size,location,and type of individual perforators in the lateral lumbar region.The surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion Image.2.One specimen also underwent whole body carboxymethylcellulose/lead oxide injection,CT scan and 3D-Reconstrution. Results An average of 1.6 DCIA perforators with a diameter of 0.7mm was present in 92% of specimens.Perforators were located 5～10 cm posterior to the anterior superior iliac spine,12～35mm above the crest,with a perforator zone of 31 cm~2.The DCIA reliably perfused the medial aspect of the iliac crest.Conclusion The DCIA reliably perfused the medial aspect of the iliac crest and lateral lumbar region.It offers a large quantity of bone on a pedicle of large diameter.The mobility of the skin component allows better tissue positioning during complex reconstructions.

Objective To provide anatomical information and clinical application of flaps based on the proximal ulnar artery perforators.Methods Ten fresh cadavers who underwent injected with artery imaging technology and dissected with layer by layer;Eighteen patients who sought surgical treatment with proximal ulnar artery perforator flap for soft tissue defects of the finger and dorsum wrist at our hospital between October 2011 and November 2012 were included in this study.Results The diameter and superficial length of the main perforator respectively were 0.5-0.9 mm and 33.0-47.0 mm in our dissection.There were 5-9 perforators given from the ulnar artery to supply skin over the medial side of the forearm.All of the 18 flaps survived after surgeries.The flap size ranged from 3.0 cm × 2.5 cm to 10.0 cm × 5.5 cm.All of the transplanted flaps presented favourable contours and good functions at 6 to 12 months' followed-up.Conclusion Proximal ulnar arter perforator flap has favourable appearance,constant vascular pedicle,reliable blood supply,and large diameter.The free transplantation of this flap offers a satisfactory alternative for repairing the small and medium-sized area of soft tissue defects of forearm and hand.

Objective To study the expression and enzyme activity of thioredoxin reductase 1 (TrxR1) in liver and peripheral blood of human and rats exposed to airborne arsenic through coal-burning as well as its role in liver injury of coal-burning-borne arsenic poisoning.Methods This study was divided into 2 parts.Part 1 was a population study:133 local residents exposed to airborne arsenic through coal-burning were selected as arsenic exposure groups including a non-patient group (25 cases),no obvious hepatopathy group (38 cases),mild (43 cases) and moderate to severe hepatopathy groups (27 cases) from areas affected by endemic arsenism in Guizhou Province.Thirty-four healthy residents from arsenic not affected areas were selected as controls.Peripheral blood samples were collected from all these people.The expression of TrxR1 mRNA was determined by real-time fluorescence quantitative PCR (qPCR),and enzyme activity of TrxR was tested by visible spectrophotometry.Part 2 was an animal experiment study:Thirty Wistar rats,weighing about 80-100 g,were divided into control group,drinking-waterborne arsenic poisoning group and coal-burning-borne arsenic poisoning group (including low,medium and high arsenic contaminated grain groups) by means of a table of random number according to body mass,6 rats in each group.The control group was fed with normal diet for 3 months; drinking-water-borne arsenic poisoning group and coal-burning-borne arsenic poisoning group were fed with 10 mg/kg As2O3 solution and different concentrations(25,50,100 mg/kg) of arsenic-containing feed,respectively,for 3 months.The expression of TrxR1 mRNA was determined by qPCR; protein expression level of TrxR1 in liver tissue was detected by immunohistochemistry,and enzyme activity of TrxR in serum and liver tissue was tested by visible spectrophotometry.Results The mRNA expressions of TrxR1 in peripheral blood were 1.599 8 (1.128 9-2.156 8),1.469 3 (1.146 1-1.976 3),1.203 6 (0.463 1-1.816 2) and 0.912 3(0.631 8-1.535 0),respectively,among non-patient group,no obvious hepatopathy group,mild and moderate to severe hepatopathy groups.Compared to the control group[1.649 7(1.161 1-2.380 2)],the differences were significant statistically in mild and moderate to severe hepatopathy groups (all P ＜ 0.05).The enzyme activity of TrxR in peripheral blood was (3.12 ± 0.76),(2.81 ± 0.84),(2.52 ± 0.73),(2.42 ± 0.76)U/ml,respectively,in those corresponding groups.Compared to the control group [(3.02 ± 0.70)U/ml],the differences were significant statistically in mild and moderate to severe hepatopathy groups (all P ＜ 0.05).The mRNA expressions of TrxR1 in peripheral blood were 1.05 ± 0.14,1.18 ± 0.18,1.04 ± 0.10 and 0.97 ± 0.13,respectively,among drinking-water-borne arsenic poisoning group,low,medium and high arsenic contaminated grain groups; all of which were lower than that in the control group (1.23 ± 0.15,all P ＜ 0.05) except that of the low arsenic contaminated grain group.The mRNA expressions of TrxR1 in liver tissue were 0.78± 0.10,0.83 ± 0.10,0.79 ± 0.09 and 0.77 ± 0.11,respectively; all of which were lower than that in the control group (0.94 ± 0.12,all P ＜ 0.05).The protein expression of TrxR1 in liver tissue was 310.33 ± 38.81,312.50 ± 23.36,305.67 ± 20.57 and 298.17 ± 23.52,respectively,among the arsenic poisoning groups; all of which were lower than that in the control group (348.50 ± 32.35,all P ＜ 0.05).The enzyme activity of TrxR in serum was (4.22 ± 0.73),(4.86 ± 0.63),(4.04 ± 0.57),(3.73 ± 0.64)U/ml,respectively; all of which were lower than that in the control group [(9.52 ± 1.08)U/ml,all P ＜ 0.05].The enzyme activity of TrxR in liver tissue was (14.82 ± 1.67),(18.76 ± 2.76),(14.90 ± 2.17),(11.55 ± 1.74) U/mg,respectively; all of which were lower than that in the control group [(23.71 ± 3.05)U/mg,all P ＜ 0.05].Conclusion Arsenic aggravates liver injury of coal-burning arsenic poisoning through down-regulating the expressions of TrxR1 mRNA and protein and reducing its enzyme activity as well.

Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.

Objective To investigate the effects of human amniotic membrane on the survival of the crossboundary perforator flap in rats through distal subcutaneous implantation.Methods From February,2016 to December,2016,38 SD rats weighing 270-300 g were randomly divided into experimental group and control group (n=19).A three-territory perforator flap (3 cm× 10 cm) with the iliac artery as the pedicel elevated on the right dorsum of the rats.Experiment group,a section of amnion was sutured to the distal subcutaneous of the flap and then the flap was sutured back to its donor site.Control group,after the flap elevated,directly sutured back to its donor site.The blood flow of the pedicel were detected by laser Doppler flowmetry at the day before surgery,1 day after surgery,3 and 7 days after surgery,with 3 rats in every group.When the rats were anesthetized,biopsies were taken from the choke area Ⅱ at the day before surgery,3 and 7 days after surgery,with 9 rats in every group.When the rats were anesthetized,HE was used to compare the diameter size of the artery and vein at the same site.At day 7,measure the survival area of the flap,and 3 of them observe the vessel of the flap by lead oxide-gelatine technique.Results The survival rate of the experimental group and the control group after 7 days were (89.09±4.23)％ and (74.56-±5.59)％ respectively,the experimental group was significantly higher than that of the control group (t=5.48,P=0.00).X-ray showed that 7 days after operation,the pedicel of iliac artery in the experimental group was bigger than that in the control group.The blood flow detection showed that the blood flow of the experimental group was higher than that of the control group (t=2.39,3.06;P=0.03,0.00,respectively) at day 1 and day 3 after surgery.Hematoxylin eosin staining showed that arteriovenous tube diameter at the Choke Ⅱ were gradually increased on the day3 and day7 after surgery in both group,but the experimental group diameter expanded multiple was higher than that of control group (t=3.52,3.50;P=0.02,0.02,respectively).Conclusion Human Amnion subcutaneous embedding may improve the blood flow of the vascular pedicle,expand the microvascular at Choke area Ⅱ,improve microcirculation,as a result to promote the survival of cross perforator flap,while the mechanism is needed to understanding.