Objective To describe the method of treating so ft tissue defects of the lower 1/3of l egs with the reversed saphenous neurocu taneous island flaps.Methods From June 1998to December 2000,eight cases of soft tissue defects or unstable scars of the lower one third of the legs,or around the ankle and th e heels were treated with reversed sap henous neurocutaneous island flaps.The size of the flaps were from 6cm ?5cm to 15cm ?9cm,averaging 9cm ?6.3c m.In 3cases in order to avoid the inju ry of the blood vessels of the flap pedicle when it passed thr ough the subcutaneous tunnel,a skin fascial bridge was designed in width of 1.5cm as the pedicle of the island f lap and to form the roof of an open tunnel.Results Seven cases had the flaps survived,one case had partially necrosis of the flap.After 6mo nths to 2years follow-up,all of the8cases were evaluated as satisfacto ry.Conclusion The blood supply of the reversed saph enous neurocuta-neous island flap is reliable,even i n patients with insufficienct arterial supply of the distal one third of t he lower limb.The flap does not sacrifice the major arteries and is easy to be perfomed.[

Objective To research the operative methods and their comments on the lower leg, ankle and the foot soft tissue defects. Methods From June 1997 to December 2005, 43 cases of the lower leg, ankle and the foot soft tissue defects were treated with nine different kinds of pedicle flaps transplant. The patients included 38 males and 5 females, with an average age of 35 years (range from 7 to 63 years). The areas of flaps were from 4 cm?3 cm to 25 cm?15 cm. 9 kinds of flaps were underwent in all patients, which includes medial or lateral gastrocnemis myocutaneous pedical flaps in 2 cases; anteromedial cross leg flaps in 2 cases; medial cross leg flap with saphenous nerve in 1 case; medial reverse flow island leg flap with posterior tibial artery in 1 case; medial distal leg fascia flaps in 2 cases; reversed sural neurocutaneous island flaps in 17 cases; reversed saphenous neurocutaneous island flaps in 14 cases; supra extramalleolus reversed island flaps in 2 cases; and medial pedes distal island flaps in 2 cases. Results 37 flaps of 43 cases were completely survived, 1 case with superficial necrosis and 5 cases with distal edge partially necrosis and these 6 cases all healed after short time dressing change. All the cases were followed up 3 months to 7 years, with an average of 16 months, and none recurred. The flaps completely survived even in some special cases such as diabetes mellitus, dorsal artery of foot defect combined venous varicose, sural nerve injury, Gustilo ⅢC open fracture and serious degloving injury of lower leg and foot. Conclusion In order to achieve the desired results, it is important to grasp the surgical indications of various kinds of flaps and keys for the operation. The sural and saphenous neurocutaneous island flaps could be a satisfactory method to treat the soft tissue defects in lower leg, ankle and foot.

Objective To investigate the characteristics of the reversed sural neurocutaneou s island flap in clinical application.Methods From June 1997to March 2002,13cases of soft tissue defect in the lower leg,or around the ankle and the heel were repaired with the reversed sural neurocutaneous island flaps.The largest flap size was 15cm ?9cm,while the smallest was 5cm ?6cm.Results11of the flaps survived well and had primary healing,while 2flaps had distal partial necrosis and healed after dressing change.The follow-u p from3months to 4years showed that all fla ps were satisfactory.Conclusion Since the blood supply of the reverse d sural neurocutaneous island flap is reliable,even in patients with insufficient blood supply,and the flap is easy and quick to get without sacrificing the major arteries,it is an ideal method to use this flap to repair the soft tis sue defect in the lower leg and around the malleolus,the heel and the Achilles tendon.[

Objective To evaluate the clinical results of operative treatments for the complex posterior tibial plateau fractures via posterior approach. Methods Eleven cases with complex posterior tibial plateau fracture from June 2008 through June 2010 were reviewed retrospectively. There were 7 males and 4females, with age from 33 years to 60 years (average, 47.8 years). According to AO classification, there were 41-B2.2.4 type in 2 cases, 41-B3.1.2 type in 3, 41-B3.3.2 type in 3, 41-B3.1.2 type combined 41-B3.3.2 type in 2, 41-C3.3 type in 1. Carlson posterior lateral approach were used in 5 cases, posterior medial approach were used in 3 cases, and posterior medial and/or lateral approach combined with anterior approach were used in 3 cases. All fractures were fixed with plates. Autogenous ilium grafts were used if necessary.Results All cases were followed up. The average follow-up time was 1.6 years (range, 3-24 months). At the final follow-up visit, bone union was obtained in all cases. The mean Rasmussen score was 16.7 (range, 15-18), and the mean HSS was 86.2 (range, 75-96). The postoperative knee range of motion were 0°-135°, 0°-130° and -10°-125° in 5 cases with posterior lateral plateau fractures, 3 cases with posterior medial plateau fractures and 3 cases with anterior and posterior plateau and intercondylar fractures respectively. There was no vascular and nerve injuries. Loosing or breaking of hardware's was not found. Conclusion The Carlson posterior lateral and/or medial approach is preferred for the complex posterior plateau fractures, with the advantages of direct reduction and stabilization.

Objective To investigate the effects of dexmedetomidine preventive on chronic postsurgical pain (CPSP) in patients undergoing hysterectomy.Methods Eighty patients scheduled for elective abdominal hysterectomy,aged 18-65 years,ASA physical status Ⅰ or Ⅱ were recruited,and randomly divided into dexmedetomidine group (group D) and the control group (group C).All patients received total intravenous anesthesia with propofol and remifentanil.The patients in group D were administered intravenously dexmedetomidine 0.5μg·kg-1 ·h-1 from anesthesia induction to extubation at the end of surgery,while the patients in group C were administered normal saline 0.125 ml·kg-1· h-1.All patients received patient-controlled analgesia with fentanyl postoperatively.Intraoperative vital signs,the dose of analgesic and sedatives,and adverse reactions were recorded.CPSP and neuropathic pain (NP) were evaluated through the telephone follow-up in 3,6 and 12 months postoperatively.Results The peri-operative vital signs of both groups were stable,and no obvious adverse reaction were observed.The dosage of tramadol used for resue analgesia in group D was lower than that in group C [(58.8±15.4) mg vs (78.9±24.5) mg,P＜0.05].Seventy-one of eighty patients completed all follow-up (37 in group D,34 in group C).The incidence of CPSP in postoperative 3,6 and 12 months were 10.8％,5.4 ％,2.7 ％ in group D,significantly lower than 35.3 ％,26.5 ％,17.6％ in group C,respectively (P＜0.05).The incidence of NP in postoperative 3 and 6 months were 2.7％,0％,significantly lower than 17.6％,14.7％ in group C,respectively (P＜0.05).Conclusion Dexmedetomidine preventive analgesia alleviate chronic post-hysterectomy pain.

Objective To investigate the regulating function of human gingival mesenchymal stem cell (GMSC) on the proliferation and differentiation of B cells and its underlying molecular mechanism. Methods GMSC were isolated and B cells were isolated from peripheral blood. GMSC or fibroblasts were co-cultured with B cells in vitro and assigned into the GMSC group and fibroblast group. The proliferation of B cells was detected in two groups. The expression of IgG1 and IgM in the cell supernatants was measured between two groups. The secretion of interleukin (IL)-6, Perforin, interferon (IFN)-γ and tumor necrosis factor (TNF)-α was compared between two groups. The expression levels ofIL-10 and transforming growth factor (TGF)-β in B cells were detected between two groups. The expression of PC-1 in B cells was measured in two groups. The signaling pathway involved with the regulating effect of GMSC on B cell function was investigated. The regulating effect of GMSC on the role of B cells in activating T cell function was assessed. Results Compared with the fibroblast group, the proliferation of B cells was significantly weakened in the GMSC group (P < 0.05). Co-culture of GMSC and B cells significantly inhibited the secretion of IgG1 and IgM from B cells and the secretion ofIL-6, Perforin, IFN-γ and TNF-α (all P < 0.05). Compared with the fibroblast group, the secretion of IL-10 and TGF-βwas significantly higher in the GMSC group (both P < 0.05). The expression level of PC-1 in the GMSC group was significantly down-regulated (P < 0.05). After adding ALK5, an inhibitor of TGF-β receptor, the inhibitory effect of GMSC upon B cells was significantly weakened (P < 0.05). Compared with the fibroblast group, the ability of B cells to activate and proliferate T cells was significantly attenuated in the GMSC group (P < 0.05). Conclusions GMSC can inhibit B cells and their mediated immune responses. The activation of B cells and other related functions can be suppressed through the TGF-β signaling pathway.