Objective To report the anatomy and clinical application of the marginal mandibular flap pedicled with facial artery in nose reconstruction. Methods Based on the anatomical study of facial artery, the reversed marginal mandibular island flap pedicled with facial artery was designed, and the nasal reconstruction with the flap was operated in 20 cases. Results In 20 cases, the maximal size of flap was 7.0 cm?6.5 cm, and the minimal size was 6.0 cm?4.5 cm, and except the distal part necrosis in one flap, and wound dehiscence in nasal collumella in another flap, all other flaps survived. Followed up for 3 months to 2 years, all reconstructed noses showed satisfactory shapes. Conclusion The method is a new design technique for nose reconstruction with ideal nose appearance, and worth to be recommended.

Objective To introduce a method of repairing the secondary vermilion defect caused by bilateral cleft lip. Methods The two side vermilion flaps beside the defect were cut along the vermilion boundary, and the lip artery was involved in the flaps. The flap may be extended to lower lip if the defect was much large. Then the two flaps were propelled to repair the defective region. Results This method was used in 15 cases, in which the biggest width of the defect was 1.2 cm, and the smallest was 1.0 cm, with all the flaps survived. The postoperative appearance of the upper lip was satisfactory. Conclusion The lip artery is constant, so the blood supply of the flap is reliable and anatomizing the flap is easy. This is a new method and can be widely used in repairing vermilion defects.

Objective To introduce the clinical application of the expanded scalp flap in the repair of baldness. Methods Based on area and shape of the baldness, two or three expanders were buried under the normal scalp galea around baldness. The scalp was expanded by intermittence injecting 0.9 % sodium chloride solution into expanders for 3 7 weeks, and then the expanded scalp flaps were used for repair of the baldness. Results Thirty expanders were used in twenty cases of patients with baldness, and all cases were satisfactory except two cases, in which the expanders exposed. Conclusion The treatment on baldness with expanded scalp flap is reliable. The donor site does not need graft skin. The scalp expansion may be the first choice in the repair of baldness.

Objective To investigate the method of repairing moderate or severe full defect of eyelid. Methods According to eyelid structure and the defect size, the two composite eyelid flaps were designed beside defect based on the arterial arch of the palpebral margins. If the defective area was too large, the lateral composite flap may be extended to lower or upper eyelid at the outer canthus, then the two flaps were propelled to the defective region to repair it. Results Eleven patients had been cured with this method since 1998. The largest length of eyelid defect was 1.7cm, and the smallest was 0.8cm. All defects exceeded 1/3 length of the upper or lower eyelid. All composite flaps survived completely without any complication. The appearance of the repaired eyelid was satisfactory. Conclusion Using the composite flap to repair the full moderate or severe full defect of eyelid is a new and effective method. It can not only provide enough tissues to repair large full defect of the upper or lower eyelid and to restore normal anatomical structure and appearance of the eyelid, but also is easy to be operated without severe secondary deformities, and the blood supply of the composite flap is reliable. The method is worth employing routinely.

Objective To introduce the anatomic basis and evaluat ion of clinical application of the pudendal-thigh island flaps us ing for vaginal reconstruction. Methods The blood supply and innervation to the skin and fascia of the pudendal-thigh region were studied in 5 female cadavers (with 10 sides). 20 patients who underwent vaginal reconstruction with pudendal-thigh island flaps were followed-up, and all the women were married for more than 3 years. Results There were multiple blood supply in the pudendal-thigh area. The cuta neous arterial vessels come from the posterior labial artery, the external pudendal artery and the anterior cutaneous branches of obturator artery. The posterior labial artery was one of the internal pudendal artery branches, a nd the diameter of it was 0.9～1.7 mm (1.3mm in average) in its original site, w hich was 22～35 mm (26mm in average) from the perineal midline. It gave off 4 ～7 branches to the major labia and the pudendal-thigh area while running alon g the lateral site of the major labia accompanying vein and nerve. 20 patients w ho were followed-up satisfied with their perineal appearance and with 10. 2 cm depth of neovagina in average. Twenty neovagina remained supple, and sexually active without difficulty. Conclusions The pedicle of the pudendal-thigh island flaps using for vaginal reconstruction is the post erior labial neurovascular bundle. The flap has reliable blood supply, survive s easily, transfers with partial sensation and few complications. This tech nique introduces a modified approch of vaginal reconstruction using bilateral pudendal- thigh island flaps with satisfactory cosmetic and functional resu lts.

Objective To probe into the application of vacuum sealing drainage (VSD) in flap with slender narrow pedicle and to observe the survival,the shaping of blood vessel,congested edema and the expression of CD34 in the flap,and to analyze the underlying mechanism of VSD on the flap survival.Methods 64 SD rats were randomly divided into 8 groups:4-hour group,8-hour group,1-day group,2-day group,3-day group,4-day group,and 6-day group.A flap was designed and put on either side of a rat's back.The both width and length of the flap were 0.8 cm and the pedicle sized in the diameter of 3.5 cm.Both sides of the flaps on the rats' backs were randomly arranged into control side and experimental side.VSD was fixed sideways to each group after the shaping of flaps.Each of the equipments was dismantled respectively in the corresponding time after the operation.Afterwards the color and swelling degree of the flaps were observed,a sample was cut and the flap survival area was measured altogether on the 7th day.Flap histology and the expression of CD34 were observed mainly through HE dyeing and immunohistochemistry.The statistical data were treated to figure out the flap survival rate and to determine whether statistical differences existed in the microvessel density (MVD).Results As the time of the negative pressure suction went on,the survival area of the experimental side flap was increasing day by day and came to the maximum on the third day (95±4)％,but no statistical difference was discerned between on the third day and on the sixth day (P＞0.05).As the time of the negative pressure suction went on,the MVD in the flap was also increasing.Statistical differences (P＜0.05) existed between the experimental side of the instant group,4-hour group and the 8-hour group and those of 3-day group,4-day group,and 6-day group.Conclusions The application of VSD can advance the survival of the flap,whose survival area can reach its maximum within 3 days under application.Besides,it can promote the increase of MVD in the flap.

Objective To investigate the application of the three-dimensional reconstruction for the random flap.Methods The bones,muscles,fascia,skin and vessels in eleven patents were reconstructed by the MIMICS 10.01 CT angiography (CTA) scanning,and the single artery and its branches were gained by the subdivision of the vessels.3D-images were shown respectively and jointly.Results Arterial reconstruction images were clearly displayed by 3D workstation CTA and if they were combined with the original cross-sectional images and vessel analysis software,they were able to accurately evaluate the location,range,degree of artery,the distal outflow tract.The vessels and soft tissue displayed in the software could show detailed distribution of the vessels in one region and this could provide the accurate anatomical basis for the random flap and the design of the operation.This method could easily meet the preoperative design demands and also had the guiding significance for postoperative evaluation.Conclusions The method of 3D-reconstruction is very good for studying the random flap and the design of the operation.

Objective To explore the anatomical basis for clinical application of the compound flap pedicled with arterial arch of palpebral margin by observing eyelid blood supply and anatomical structure and to prove that it is an ideal method of repairing the eyelid defect for clinical application. Methods 15 adult cadavers (30 eyelids) were dissected. The origin, course, branches, diameters and vessel networks of palpebral margin arterial arch were observed particularly. 30 cases of eyelid marginal defect were reviewed and the therapeutic effect of this method evaluated. Results Eyelid was constituted by 5 layers: skin, subcutaneous tissue, muscle, tarsal plate and conjunctival layers. Most eyelid vessels were mutually anastomosed to form a constant vessel network. Palpebral margin arterial arch and peripheral arterial arch were formed by dorsal nasal artery branches and lacrimal artery branches, both of which nourished the eyelid tissue. All the compound flaps of 30 cases survived completely without any complications. All cases obtained satisfactory results functionally and esthetically. Conclusions The arterial arch of palpebral margin is constant and the blood supply of the compound flap is reliable. It can repair full eyelid defect with the same kind of tissue, and obtain satisfactory appearance. It is an ideal method of repairing the eyelid defect.

Objective To detect the expression of SDF-1 and CD34,and MVD changes at slen der narrow pedicle flap of hypoxia and ischemia during the survival process,and to investigate the role of SDF-1 at flap neovascularization.Methods The slender narrow pedicle flaps,which pedicle's length-breadth ratio were 4 ∶ 2,and the flap size of each took an area of 2 cm × 2 cm (group A),3 cm ×3 cm (group B),4 cm × 4 cm (group C),5 cm × 5 cm (group D) and 6 cm × 6 cm (group E),were designed and elevated on each pigs' double dorsum.The flaps were served as a hypoxia/ischemia flap model.The survival area,histologic analysis,SDF-1 and CD34 enzyme-linked immunosorbent assay at the distal flap were evaluated at days 0,3,5,7,and 14 after operation,respectively.Results In the each group of flaps,the expression of SDF-1,CD34 and MVD increased with time,reached the plateau level after 5 days (maximal values of SDF-1:124.80 ± 4.05 ingroup A,137.85 ±3.03 in group B,166.53 ± 2.98 in group C,72.80 ± 2.63 in group D and 62.79 ± 2.20 in group E),7 days ( maximal values of CD34:16.76 ± 0.62,17.60 ± 0.72,18.48 ± 0.55,12.70 ± 0.60,and 11.51 ± 0.70,each group),and 7 days (maximal values of MVD:52.45 ± 2.78,59.34 ± 3.12,61.14 ± 3.35,25.25 ± 3.78,and 24.46 ± 7.46,each group),and then gradually decreased.In the different groups of flaps,when the flap area increased,the expression of SDF-1,CD34 and MVD increased,but the parameters decreased at the area of 5 cm × 5 cm,and the flaps were partial necrosis.Conclusions SDF-1 may play an adjusted role in the survival process of the slender narrow pedicle flap.

Objective To study the function of hypoxia mimics of different exposure time of deferasirox in improving the growth of micrangium in a narrow pedicle flap.Methods Fourty male SD rats were divided into 2 groups:experimental group was fed with deferasirox 100 mg/kg per day from 1d,3d,5d and 7d,respectively,before the surgery of transferring the narrow pedicle flap,while control group just fed with saline.After 7 days,the immunohistochemistry,Western blot and quantitative reverse transcription-PCR (qPCR) were performed to examine the expression of CD34.qPCR was used to examine the expression of HIF-1α,VEGF in order to investigate the regulatory effect of deferasirox in improving the growth of micrangium and the distinction among the different exposed time of deferasirox in the narrow pedicle flap.Results The deferasirox group exhibited a marked improvement in flap healing time,and with the increasing administration time of deferasirox,the expression of MVD,HIF-1α and VEGF was improved in each treated group (P＜0.05).Conclusions Deferasirox can induce HIF-1α secretion and increase CD34 expression,and so deferasirox can protect endothelial cells from hypoxic and ischaemic injury.