Objective To explore the effectiveness of remediation of antimicrobials in a third-grade class-A hospital .Methods Using retrospective analysis to analyze the clinical application of antimicrobials related data during July .2011 to Nov .2011(before remediation) and July .2012 to Nov .2012(after remediation) .Results The ratio of antimicrobial cost ,the proportion of outpatient antimicrobial prescribing ,inpatient antimicrobial usage and AUD fell respectively from 13 .73% ,16 .97% ,59 .93% and 72 .71 DDDs/100 persons day before remediation to 7 .37% ,13 .83% ,44 .88% and 40 .08 DDDs/100 persons day after remediation ;indica-tors of antibacterial use in clean surgery improved greatly ;the structure of antibacterials changed significantly .Conclusion After extensive antimicrobial special rectification ,the clinical use of antimicrobials is rationalized ,a number of indicators are in line with the Ministry of Health ,its management experience is worth using for reference .But there are still some problems which call for at-tention .

OBJECTIVETo investigate the effect of vascularized composite flap with iliac crest and nternal oblique muscle of abdomen for half mandibular reconstruction.

METHODSFrom July 2009 to Sept. 2013, 14 cases with half mandibular defect after tumor resection were treated with composite flap of iliac crest and internal oblique muscle of abdomen pedicled by deep circumflex iliac vessels. During operation, one group performed tumor resection and got the recipient area vessels ready for anastomosis. The other group performed harvesting of composite flap. Then the flap was trimmed and fixed to construct the defect with vessel anastomosis.

RESULTSAll the 14 composite flaps survived with local infection only in 1 case. The size of harvested iliac crest ranged from 6 cm x 3 cm to 9 cm x 3 cm. The size of harvested internal oblique muscle of abdomen ranged from 5 cm x 4 cm to 7 cm x 5 cm. The patients were followed up for 6 months to 26 months (mean, 13 months) with satisfactory results and no complication. Mandibular panoramic radiographs showed new bone formation and good union.

CONCLUSIONSVascularized composite flap with iliac crest and internal oblique muscle of abdomen has the advantages of abundant bone volume, as well as soft tissue reconstruction in one stage. The reconstructed mandible can attain normal function and appearance.

Abdominal Muscles ; transplantation ; Abdominal Wall ; Humans ; Ilium ; transplantation ; Mandibular Reconstruction ; methods ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply ; transplantation