Objective To study the method and effect of deep inferior epigastric perforator flap(DIEP)in repairing the large defects of lower limbs.Methods Eight cases,from July 2009 to November 2011,including 3 cases of plantar skin defects with bone exposure after foot injuries,three cases of plate exposure after tibia fracture surgery and 2 cases of heel repeated ulceration after skin graft,were repaired by deep inferior epigastric perforator flap.Results All deep inferior epigastric perforator flaps survived with good functions,except 1 case whose distal with poor blood supply and the flap survived after treatmenting,three cases of flap bloated with good appearances after second operation.Conclusion DIEP is a proper option for repair of large defects of lower limbs.It has the advantages of abundant blood supply,large flap area,abdomen can suturing without abdominal complications.

Objective To evaluate the effectiveness and safety of autologous granular fat graft applied for penile lengthening and augmentation.Methods After all the superficial ligment and 1/3-2/ 3 part of the deep suspensory-ligament had been cut off for penile lengthening,local pedicaled fasciaadipose flap was designed to fill the depression,the pre-centrifuged autologous granular fat was injected into the space beneath Buck's fascia for penile augmentation.Normal length,pulling penis length,diameter,circumference and complications were evaluated.Results 34 cases were performed and followed up for 3-18 months,both ideal length and diameter increase of penis were achieved.The differences of nomal length,pulling-length,the diameter and circumference were (2.8±0.1) cm,(2.1±0.2) cm,(0.9 ± 0.1) cm,(2.8 ± 0.1) cm,respectively.The common complications included poor wound healing in 4 cases,preputial edema and subcutaneous scleroma in 8 cases for 3 months.Conclusions Autologous granular fat graft for penile augmentation during the lengthening surgery is a reliable and effective method and easy procedure.Detail processing can decrease the complications.

Objective To explore the aesthetic effect of the applying the expanded skin flap to re-pair facial defects produced by removal of nevus, hemangioma, scars and so on. Methods The experience of the treating 67 patients with facial lesions using the expanded flaps were reviewed. The proper expand-ers were chosen according to the scope of the facial lesion. The incision was located at the scar region and the dissection was executed in the superficial layer of the SMAS. The interspace was larger than the ex-pander by 1.0～1.5 cm. After exact hemostasis, the expanders and negative pressure drainage tubes were placed into the interspace. The design of the facial expanded skin flap included the advance, rotation, and transposition of skin flap and so on. The advance of skin flap took fully use of the expanded skin flap without the donor site defect. The transposition of skin flap also took fully use of the expanded skin flap, furthermore, it overcame the displacement and the disfiguration caused by the applying of the advance skin flap and rotation skin flap. The incisions in face were designed to a minimal extent and parallel to the Lan-ger line. Results All of the 67 cases got aesthetic satisfied results with all the flaps surviving. Conclusion The application of expanded skin flaps is proved to be an effective way of repairing facial wound when there is enough normal facial skin for expansion.

Objective To explore a better method to repair cervical cicatricle contracture deformity.Methods The cervicai cicatrical contraction deformity was repaird by the cervico-shoulder island skin flap with blood supply crossing and abundant anastomotic branches of the neck-shoulder blood vessels. After removing the cervical scar, the flaps were designed according to the size of the wound to be repaired, and the clinical anatomy of crossing and abundant anastomotic branches of the neck-shoulder blood vessels. The secondary wound of donor site was closed directly if the donor region was small, or closed by skin graft. Results Sixteen patients in this clinic were operated with this method, and venous return dysfunction occurred in 1 case, but blood circulation was improved after treatment. All the flaps survived with good appearance and texture. The extensive flap was created and transferred to the anterior neck by one stage without pre-expansion which met some patients'requirement of repairing cervical cicatricle contracture deformity. Conclusion The cervico-shoulder island skin flap, with abundant blood supply, is a new method to repair cervical cicatricle contracture deformity.

Objective To explore a novel strategy to repair traumatic soft tissue defects in the head and face by tissue expansion in the early stage.Methods Eighteen patients with traumatic soft tissue defects were treated with thorough debridement leaving the wound unclosed or simply closed with thin split-thickness scalp skin grafting,and adjacent expander implantation in the early stage and expanded flap transposition in the second stage.Results There were 11 male patients and 7 female patients ranging in age from 3.5 to 40 years [mean,(19.4±12.2) years],with average 15 months follow-up (range,3-67 months).The average expansion time was 74.3 days (range,53-96 days).The total of 18 patients with 22 expanders were treated with satisfactory results.All the flaps survived and the skin color,texture and contour well matched to those of the peripheral tissue.Only one complication of infection happened in the 18 cases (5.56％) and total 22 expanders (4.55％),which was similar to the rate reported in the literature.There were no any other complications related to the expander.Conclusions Debridement and tissue expansion in the early stage have been proved a more effective strategy to repair traumatic soft tissue defects in the head and face,which can not only achieve satisfactory color,unbulky and well matched texture similar to normal,but also can avoid unnecessary donor site injuries and does not increase the infection rate of tissue expansion.

The experiment aimed to study the toxic effect of oral ricin on gastrointestinal tract and immune organs of mice with the dose of 1/5 LD50.In early days of intoxication,there was an obviously decrease in daffy weight and relative weight of thymus and spleen,fllowing the excretion of toxin,they had a trend of recovering to the normal state.Also,results of pathological section,scanning electron microscope and transmission electron microscope showed that ricin would induce a series of pathological reaction in intestines,meanwhile,the splenocytes displayed significant symptom of apoptosis and necrosis.

Objective To explore the technique of massive facial scar revision. Methods All 12 patients in the group were treated with expanded deltopectoral skin flap. In the primary surgery, expander was implanted underneath deltopectoral flap region through an incision inferior to the clavi-cle. The skin perforators of transverse cervical artery and thoracoacromial artery were ligated during surgery, and the internal thoracic artery was carefully preserved. After the deltopectoral skin flap was fully expanded, the second surgery was performed and the facial scar was released and the normal ana-tomic position of eyes, nose and month was restored. The deltopectoral skin flap was planed according to the size of the defect. The excised facial scar was converted to the flap pedicle and a hinge-like con-nection was formed. The flap was delayed and three weeks after the second surgery, the pedicle was divided. The flap from the pedicle was applied for the mental region scar revision. Results Unilateral or bilateral dehopectoral skin flaps were employed for the repair of extensive facial scar in 12 patients. Satisfactory results were achieved in all these patients. Conclusion Expanded deltopectoral skin flap is a good technique for the repair of extensive facial scar.

OBJECTIVETo investigate the influence of the endothelial cells on the scar-derived fibroblasts in the hypertropic scar tissue.

METHODSThe endothelial cell from the human umbilical vein was cultured and its supernatant was then collected. Thereafter, it was mixed with the pre-cultured scar-derived fibroblasts from the hypertropic scar tissue. The fibroblasts were analyzed with a flow cytometer in a MTT-assay method to evaluate the cell proliferation and its division cycle.

RESULTSThe endothelial cells were significantly increasing the scar-derived fibroblast proliferation (P < 0.05), compared with the control. The proportion of the fibroblasts in the S-stage of cell cycle was also quite high.

CONCLUSIONThe endothelial cells may secrete some active products, which may enhance the proliferation of the scar-derived fibroblasts and stimulate the fibroblasts into the S-stage of cell generation cycle.

Cell Cycle ; drug effects ; Cell Division ; drug effects ; Cell Line ; Cells, Cultured ; Cicatrix, Hypertrophic ; pathology ; Culture Media, Conditioned ; chemistry ; pharmacology ; Dose-Response Relationship, Drug ; Endothelium, Vascular ; chemistry ; cytology ; Fibroblasts ; drug effects ; pathology ; Humans

Objective: This study aimed to present our clinical experience using a novel method for autologus costal cartilage framework fabricationin fully expansion technique ear reconstruction without skin graft. Methods: During Steptember 2016 to Steptember 2017, autologus costal cartilage framework with expansion technique were performed for 63 patients with microtia. Autologous costal cartilage was stacked up to form the structure and height, the natural appearance of auriculocephalic angle was achieved at the same stage, so the second-stage elevation of ear and postauricular skin graft was unnecessary. The delicate structure of the reconstructed ear and ideal bilateral symmetry were achieved by the optimized cartilage stack-up. Results: Three patients out of total 63 patients had cartilage frame work exposure, and were treated with superficial temporal fascia transfer combined with skin graft. The rest 60 patients had satisfied results. Follow-up ranged from 8 months to 18 months and 12 months follow-up was on average. The novel frame work fabrication method was based on the sufficient full pre-expansion procedure. The ideal structure, bilateral symmetry, and excellent definition of the framework, as well as the natural dorsal appearance of the reconstructed auricular were achieved. Conclusions The cartilage " stack-up" method is essential for the full expansion without skin grafts ear reconstruction technique. The combination of the cartilage " stack-up" framework fabrication and full pre-expansion provide a well-defined, well-projected and bilateral symmetrical ear.

Objective To evaluate the clinical outcome of reduction plasty for labia minora hy-pertrophy with redundant praeputium clitoridis .Methods A total of 84 cases were included from June 2013 to December 2016 .Arc-shaped resection of labia minora and crescent resection of redundant pra-eputium clitoridis were the two essntial surgical procedure ,and 5-0 VICRYL Rapide was used for su-turing the incision .Results The 84 cases were operated with this mothod with satisfactory aesthetic result .Complications ,such as hematoma ,infection and poor wound healing ,were not observed .Ede-ma was resoluted after one to two weeks .After the reduction plasty of the labial labia ,the vagina and perineum were completely covered in the natural state ,without scar ,also the sensitivity of clitoris was improved due to the better expoure post-operationally .Conclusions The same-stage reduction plasty for labia minora hypertrophy with redundant praeputium clitoridis is a reliable and effective method . Both satisfactory aesthetic result and improved sexual sensitivity are achived ,without hematoma ,in-fection and poor wound healing .