ObjectiveTo investigate the clinical effects of applying low abdominal superficial artery flap to repair skin and soft tissues defects in upper limbs.MethodsTotal 42 cases with soft tissues defects were recruited in this study.Seven cases were repaired using skin flaps with circumfiexa ilium superficial artery.Five cases were repaired using osteocutaneous flaps based on circumfiexa ilium superficial artery.Eleven cases were repaired using flaps with superficial epigastric artery.Seven cases were repaired using flaps with circumfiexa ilium superficial artery,lateral branches of superficial epigastric artery and musculocutaneous perforators of the fourth lumbar artery.Six cases were repaired using flaps with origin of circumfiexa ilium superficial artery,medial and lateral branch of superficial epigastric artery,and the deep and cutaneous branch of circumfiexa ilium superficial artery.ResultsAfter surgery,forty-two flaps all survived.Flaps areas were between 5 cm × 6 cm-9 cm × 30 cm.Followed up 6-24 months,the appearance,texture,color and function of flaps were recovered well and did not need to trim again.ConclusionLow abnominal superficial artery flap could be used to repair skin and soft tissues,also its texture is so thin and areas can be direct sutures,which,is an ideal method to forearm repairment.

Aim To evaluate the effects of notoginsen-oside R1 on store-operated calcium entry ( SOCE ) in pulmonary arterial smooth muscle cells ( PASMCs ) of chronic hypoxia ( CH)-and monocrotaline ( MCT)-in-duced pulmonary hypertension ( PH) rats. Methods Mn2+ quenching of Fura-2 and measurement of intra-cellular free calcium concentration ( [ Ca2+] i ) using fluo-3 were examined in PASMCs of CH-exposed and MCT-treated rats. Results ①CH-exposed and MCT-treated rats exhibited profound PH when examined 3 weeks after hypoxia exposure or MCT injection, respec-tively. ②In the presence of 3 μmol·L-1 nifedipine, 10 μmol · L-1 notoginsenoside R1 significantly re-duced cyclopiazonic acid ( CPA )-induced the percent reduction in Fura-2 fluorescence measured 500 sec af-ter application of Mn2+, the maximal rate of Mn2+quenching, the amplitude of the Ca2+ influx transient and the resting [ Ca2+] i in PASMCs of CH-exposed and MCT-treated rats. Conclusion Notoginsenoside R1 inhibits SOCE and reduces resting [ Ca2+] i in PASMCs of CH-and MCT-induced PH rats.

Objective To explore the operative technique and clinical outcomes of tiled flaps from foot with bone graft for reconstruction of thumb defects.Methods From January, 2008 to December, 2013, 8 cases of thumb defects with varying degrees were treated with tiled flaps from foot and iliac bone graft.Among them, 4 cases caused by emergency trauma, the other 4 cases was old defect after trauma, including 1 case of double thumb defect that caused by electrical burn.The thumb defects was caterorized as type Ⅰ A in 1 case, type Ⅰ B in 2 cases, type Ⅱ A in 1 case, type ⅡB in 2 cases and type ⅢA in 2 cases.Five cases in which were treated with free wrap-around flap from the ipsilateral big toe and tibial lateral-flap from the opposite second toe, 3 cases using free wrap-around flap with series connection of dorsal artery.Results All 8 reconstructed thumbs were survived.The wound healed primarily.In 1 case, the unhealed wound was healing after dressing where skin grafts in the donor sites of the foot were partial necrosis.Postoperative follow-up ranged from 6 to 72 months, the appearance of the thumb was satisfying when was compared with normal thumb.Thumb nail grew well, the blood supply was good, and sensory recovery from S2 to S4.According to the criteria issued by the Hand Surgery Society of Chinese Medical Association for functional assessment of reconstucted thumb and fingers, 5 were excellent and 3 were good.The donor site skin graft had no scar contracture and no ulceration.There was no apparent impairment on the foot function.Conclusion Combined tiled flaps from foot and iliac bone graft for reconstruction of thumb is a good method, which can recover the appearance of thumb without sacrificing toes of the donor foot.

Objective To explore the clinical outcomes of three types of multiple flaps from the foot for re-construction of two skin and soft tissue defects in hands. Methods From February, 2003 to September, 2015, 23 cases of hands with two skin and soft tissue defects were treated with 3 types of multiple flaps from the foot. Among of them, 10 cases of adjacent fingers were treated with double foliated pulp flaps from the big toe and the second toe based on a single vascular pedicle of the first dorsal metatarsal vessels; 2 cases of composite tissue defect including finger and hand were treated with double foliated pulp flaps from dorsalis pedis flap and the big toe based on a single vascular pedicle of the dorsalis pedis artery;11 cases of two composite tissue defect in hand were treated with dorsalis pedis flaps based on a single vascular pedicle of the dorsalis pedis artery. The donor site was covered with full-thick-ness skin. All patients were followed-up regularly which included three aspects:appearance, hand function and senso-ry recovery. Results Twenty-three cases of double foliated pulp flaps were survived. Postoperative follow-up time ranged from 3 to 36 months, with an average of 15 months. The postoperative follow-up revealed satisfactory shapes of the multiple flaps and recovery of functions. The sensation was recovered to S 2-S4. The grafting skin in donor site sur-vived completely excluding partial necrosis in 3 cases. The wound were treated by wound dressing, local scar hyper-plasia in donor sites. There was no apparent impairment on the foot function. Conclusion Three types of multiple flaps from the foot based on a single vascular pedicle for reconstruction of two skin and soft tissue defects in hand could achieve good clinical outcomes. The type of flaps can be adapted according to the injury.

Objective To explore the clinical effect of complete transposition of arteriovenous in free flap artery crisis. Methods From October, 2009 to April, 2017, 13 cases of extremities tissue defect were repaired with free flaps.The intractable arterial crisis appeared after transplantation.Repeated anastomosis vessels were adapted but it was not relieved. Then the complete transposition of arteriovenous was adapted in the flaps. Namely the vein of the flap was anastomosed with the arterial in the recipient site to reconstruct the blood supply, and the arterial of the flap was anastomosed with the vein in the recipient site to reconstruct recirculation.Ten cases of hand defect and 3 cases of crus defect were repaired by 5 low abdominal flaps and 8 anterolateral thigh flaps. The tissue defect area was 16 cm× 7 cm-6 cm×4 cm and the flap area was 18 cm×8 cm-7 cm×4 cm. Results Ten flaps survived completely, the other 3 flaps almost survived that scab healed in 1 case and skin grafted in 2 cases. The flap for skin color was from purple red to dark red, and finally close to normal, and skin flap edge would have different degrees of ecchymosis; the bleed-ing from the incision of the skin flap was from dark red to bright red; the swelling of the flap was obvious in the early stage and the later swelling subsided. All cases were followed-up from 6 months to 32 months with an average of 16 months.The wounds healed well.The flaps had a clear boundary and soft texture. Conclusion Complete transposi-tion of the arteriovenous system can be used as an alternative in the presence of intractable arterial crisis after free flap transplantation, to save the flap and to reduce the trauma to the patient.

Objective To explore the surgical method and clinical effect of repairing the large area skin defect of forearm with the perforator flap pedicle with the inferior epigastric artery perforator and the lateral cutaneous branch of the posterior intercostal artery.Methods From January,2006 to January,2016,14 cases of forearm large area of skin defects were treated with the ovedength flap at one stage.The proximal flap to the inferior epigastric artery umbilical perforation and the flap distal to the posterior interphalangeal artery perforation were used for the blood supply of superficial flap.The length of the flap was 25-43 cm (average,36 cm).The width of the flap was 5-14 cm (average,9 cm).All patients were followed-up regularly.The content of the follow-up included three aspects:appearance,hand function and the recovery of the donor site.Results Twelve cases of postoperative flaps successfully survived.Arterial crisis was seen in 1 flap 28 hours after surgery.The re-surgical exploration was adopted after conservation treatment for 1 h without remission and the proximal anastomotic flap embolization was confirmed.The flap survived.Venous crisis was seen in 1 case.The flap survived with the help of removing the suture,smoothing drainage and bleeding for 5 d.The wounds and the donor site of the thoracic and abdominal region healed at the first stage.The follow-up time was 8-72 months,with an average of 31 months.The flaps had no obvious bloated,the skin texture was close to forearm skin and the flaps were restored protected sensation.There was no ulceration,infection and other complications.The healing of skin graft was satisfactory in 2 cases in abdominal donor site.No skin graft contracture occurred.The remaining 12 cases had linear scar in the abdomen of the donor site.The edge of the scar was soft and no obvious contracture occurred.Conclusion Super long thoracic umbilical conjoined perforator flap can repair the lager area skin defect of forearm with double blood supply.The length of flap is significantly longer with enoughblood-supply of distal part of the flap.The clinical efffect is satisfactory.

Objective: To report the operation methods and clinical effects of repairing finger tip defect with the free tibial dorsal nerve flap of the second toe. Methods: 13 patients with finger tip defects were repaired by the tibial dorsal nerve flap of the second toe. The area of finger tip defect was 2.5 cm×1.5 cm-1.3 cm×1.0 cm, and the area of cutting flap was 2.7 cm×1.7 cm-1.5 cm×1.1 cm. All donor site defects on the second toe were covered with full-thickness skin graft. Results: There were 13 cases in this group, and all the flaps and skin grafts were survived. Postoperative follow-up ranged from 6 to 18 months, with an average of 13 months. The appearance of the fingers was satisfied and the sensory recovery was good. Two-point discrimination of the flaps returned to 7-13 mm, with an average of 9 mm. According to the total active move(TAM)scale, results were excellent in 11 fingers, good in 1 finger, and fair in 1 finger. The donor site skin graft was well healed, the second toe pulp was full, and the two-point discrimination of the toe pulps were 6-10 mm, with an average of 8 mm. Conclusions Compared to the traditional method of repairing finger tip defect with the tibial inherent nerve flap of the second toe, our new method can reduce the damage to the donor site, and we can repair finger tip defect as well as the traditional one at the same time. So it was a better operative method to repair finger tip defect with the tibial dorsal nerve flap of the second toe.

【Objective】 To evaluate the necessity and rationality of setting 0.8 CO of the gray area of hepatitis B surface antigen(ELISA) reagent in our laboratory. 【Methods】 1) 792 samples of serum plates from the Clinical Laboratory Centre, Ministry of Health (NCCL) were tested by two HBsAg ELISA reagents. The true positive rate, and confirmed positive rate of gray area samples revealed by 2 reagents were calculated. ROC curve was drawn to determine the best CO value of 2 reagents. The changes in sensitivity and specificity under different CO values were compared. 2) Based on previous data, the HBV-DNA-yield rate among HBsAg gray area samples was analyzed, and the relationship between the distribution of ELISA results of solo HBV-DNA positive samples and gray area was analyzed. 【Results】 Of the 792 samples that form NCCL, 587 were positive, 197 negative and 8 indeterminate. The true positive detection rates of reagents A and B were 82.45% and 71.89%. The confirmed positive rate of gray area samples given by 2 reagents were 94.74%(18/19)and 93.10%(27/29). The best CO values of reagents A and B are 0.49 and 0.27, which are both lower than the 0.8. The specificity corresponding to the best CO values of the two reagents decreased slightly, but the sensitivity increased greatly. From January 2015 to January 2019, 183 551 samples were tested. Of the 13 cases of HBsAg gray area samples, 7 were revealed by reagent A and 1 was positive for NAT; 6 were revealed byreagent B and all negative for NAT. Out of 134 cases of solo HBV-DNA positive samples, 96.27% (129/134) samples had S/CO values below 0.4, overlapped with negative samples, and were far from 0.8. 【Conclusion】 It is necessary to set gray area for these two HBsAg ELISA reagents. The gray area value setting to 0.8 CO corresponds to poor reagent sensitivity. The best cutoff value would be selected according to the ROC curve: 0.49 CO in Reagent A and 0.27 CO in Reagent B. Gray area has no obvious effect on screening of single-virus NAT-yield sample.