Microsurgery has been in a plateau period after a development of 4 decades. Now it has been faced with a difficult situation in China: shrinking scope and increasingly slow development. This may be an inevitable outcome of the spiral rising pattern of development of anything in the world, as well as a combined result of fierce impact of market economy, hysteresis of medical system, ideological deviation and investment deficiency. Recently, however, application of new and high technology, new devices and materials in microsurgery, such as nanometer techniques and materials, gene and tissue engineering, and computerization, has broadened a new development space. Microsurgery in the 21st century should make more efforts in expanding its application dimension, perfecting its therapeutic methods, enhancing basic research, raising technical proficiency of its personnel and improving the welfare of its workers. It should also be nourished with new ideas, interdisciplinary cooperation before it can realize its rejuvenation in the new century.

This article reviews the currently most widely used methods and their features of the non operative and operative treatment for the fractures of long tubular bones. It is widely accepted that each of the two methods is useful in its injury degree and in kind. It is wise to choose the non operative treatment for child fractures, adult fractures easily reduced, and the complementary therapy after surgery. External bone fixation is preferentially selected as for the open long tubular bone fracture with severe injuries to the soft tissues, early freatments of long tubular bone fracture with multiple injuries all over the body and fire arm injury. While it is widely accept that an active operative treatment should be take for the open fractures, multiple fractures, multi plane fractures, intraarticular fractures, and the fractures with vessel or nerve injury, and the biological fixation should be chosen in order not to impair circulartory supply of soft tissues. Arriving at the conclusions that future studies of the treatments for the fractures of long tubular bones will be conducted in meticulously design for therapy, minimally invasive osteosynthesis, satisfactory reduction, stably biological fixation, immediately active motion and results in a good runctional recovery for the limbs.

Recent years have witnessed an extre mely rapid development in minimally invasive surgery(MIS).It is widely accepted that treatmen t of bone fractures should be shifted from biomechanical fixation to biological fixation in order to gain a minimal invasion and good function al recovery.Minimally invasive tec hniques have been widely applied in clinics,such as procedures assisted by arthr oscope in orthopedics and endoscope in spine surgery,percutaneous treatm ent of the fractures and diseases of l imbs and spines.They have also been enhanced by the computer-assisted s urgical navigation system,surgical simulation system,telepresence c onsul-tation system and robotic remote-co ntrol surgery.Application of MIS in microsurgery has been documented to be able to decrease the notorious donor site morbidity while maintaining th e quality and costs of outcomes.Adva nces in image technique and intervention al radiology have greatly improved minimally invasive methods to be used in orthopedics.MIS has also found new p ossible and potential therapeutic means in such technologies as laser,microwave,cryoablation,ultrason ofocusing,nanotechnology,gene th erapy and tissue engineering.In short,since the scope of MIS will keep on exp anding during the 21st century,it is certain that MIS will see an in-creasingly bright future and become a mainstay in orthopedics.

Virtual reality that is based on the high and new technology has witnessed great progress since the end of 20th century. It will result in promising methods to be used widely in clinic and to promote the development of minimally invasive surgery (MIS). As far as MIS is concerned, it will reshape the principles, expand the scope and improve the result of diagnose and treatment. Furthermore, it will also accelerate innovation of the instrument for MIS. The development of virtual reality, however, is still at its beginning. Not only high-level specialists but also expensive and special equipment is needed to explore virtual reality before it can be applied in MIS. As a result, virtual technology should be applied step by step, first in the most suitable indications. Meanwhile basic and applied research on virtual reality should be forcefully carried on to render it into effective and practical methods for the minimally invasive or non-invasive surgical treatment.

The study of mechanical properties on heart valves can provide an important theoretical basis for doctors to repair heart valves and prosthetic valve materials research. In this paper, we present the current status of the mechanical property study methods of heart valve, expound the methods and special requirements about uniaxial tensile test and biaxial tensile test of the heart valve, and further discuss several establishment methods of heart valve constitutive models. We also discuss the development trend of heart valve mechanics.
Heart Valve Prosthesis ; Heart Valves ; physiology ; Humans ; Prostheses and Implants

ObjectiveTo discuss the clinic application and surgical technique of the free flap by inverted-Y-shape microvascular anastomosis in tissue defect repair and functional reconstruction of the limb.Methods Twenty-two flaps in 18 patients were involved in the study between June 2006 and September 2010( 12 cases for soft tissue defect repair with exposure of the tendons, bones or joints, and 6 cases for functional reconstruction;five cases were around the elbows and 13 cases were around the extremity of the lower limb). Before free flap graft, twelve cases with infective tissue defect were debrided extensively and covered with vacuum sealing drainage from 1 to 2 times and each time last 5 to 7 days until the granulation tissue growing well.Designed the free anterolateral thigh flaps with the transverse and descending branches of the lateral femoral circumflex vessels or free latissimus dorsi flaps with the subscapular and circumflex scapular vessels forming a inverted-Y-shape pedicle to repair the tissue defect or to reconstruct the limb function.The recipient artery was sectioned and the arterial tree of the flap was anastomosed to the recipient vessel by two end-to-end anastomoses.This inverted-Y-shape microvascular anastomosis could supply blood for both the free flap and the extremity of the limb.Not all of the veins of the recipient limb need to be cut off.Observed the circulation of the limb extremity, and evaluated the quality of flaps'survival.ResultsComplete flap survival was achieved in 21 flaps and without vaso-occlusive crisis;while partial flap loss in 1 case, which healed after changing dressings.The mean follow-up was 16.2 (6-36) months postoperatively,appearance of the flaps and the functions of limbs were satisfactory,and no obvious complication was found in the donor site.ConclusionThe free flap by inverted-Y-shape microvascular anastomosis is a new choice for the tissue defect repair and functional reconstruction of the limb,especially for the wound around elbow or extremity of the lower limb with one major artery destroyed.

Objective To investigate the effect of IGF-1 on the TGF-β3 induced chondrogenesis of MSCs encapsulated in alginate beads and its application in cartilage tissue engineering.Methods MSC chondrogenesis in alginate beads was induced by TGF-β3 and/or IGF-1.Collagen type Ⅱ,aggrecan and Sox-9 expression was evaluated by immunostaining,RT-PCR and Western blot,respectively.Scanning electron microscope and laser confocal microscope were used to observe the differentiated chondrocytes when cultured on the chitosan-based scaffold.Results TGF-β3 with IGF-1 induced MSCs in alginate beads to express the higher level of collagen type Ⅱ,aggrecan and Sox-9 than any other growth factor alone (P＜0.05).The correlation coefficient between Sox9 and collagen type Ⅱ or aggrecan was 0.95 and 0.91,respectively.The chitosan-based scaffold supported the cell's adhesion,migration and proliferation.Conlusion IGF-1 enhances the TGF-β3-induced MSC chondrogenesis via upregulating Sox9 expression.The chitosan-based scaffold is biocompatible with the differentiated chondrocytes.

Objective To study a new method of correcting flaring ear. Methods Auricular cartilage was slited from posterior auricula. On Gibson's principle of cartilage distortion antero-lateral cartilage membrane was scarified in order of the involute interpolation of anthelix and cartilage membrance was ground. Then the cartilage outside the slited line was put behind the cartilage inside the slited line. Finally,cartilage was operated with Mustarde's mattres suture. Results 12 patients with flaring ear ( 14 ears) were corrected with this operating method and appearance of corrected ears were very good after operation. Following up for 6-18 months, no one recurred. Conclusion Otoplasty of slited cartilage is an effective method of correcting flaring ear.

OBJECTIVE To probe current status on protection of occupational exposure for contract workers in supply center of military hospital,therefore to put forward rational suggestion and measure.METHODS Current status among contract workers in supply center of military hospital were investigated by questionnaire with conversation.RESULTS The investigation showed that contract workers in supply center of military hospital had poor recognition on protection of occupational exposure,with higher prevalence of occupational exposure(95%),and short of effective protection against occupational exposure,and without correct and efficient measures once occupational exposure occurred.CONCLUSIONS It is essential to enhance education on occupational exposure protection,establish strict,systemic and periodic training,thus to strengthen self-protection on occupational exposure,therefore to reduce the occurrence of inhospital infection.

Objective To make an inquiry into how to reconstruct a lifelike ear, and which is one of the most thorny problem in plastic surgery. Methods The operation was divided into two stages: the first stage was that an expander was put into a patient's opisthotic subscutaneous region and lobe of the ear was transposed or laid aside; the second stage was that the expander was taken off by a 2.5～3.0 ㎝ incision at the top or bottom of the expanded flap. The reniform incision except the preauriclar pedical part which was 0.5～0.6 ㎝ away from the expander edge was slit until the deep fascia and dissected forword at the same layer in order to form a "bag-shape" flap. Then, an auricle model was put and fixed and aspirating tube was inserted in the "bag". The back of the reconstructive ear was repaired with the full thickness graft. Results It made operating procedure simple, negative pressure plasty looked good, the blood circuit of flap was increased and occurrence rate of complication reduced. The operation had been performed on 18 patients with a satisfactory results. Conclusion The success rate of the procedure is higher and the shape of the reconstructed ear is more lifelike than that of the traditional one.