Because of massive defects requiring repair, a flap with blood supply of extraterritorial blood vessels is often needed clinically, which is a little bigger than that with blood supply of axial blood vessels. In order to provide theoretical evidence for the survival of such a flap, we designed a 11cm ? 15 cm flap involving the thoracodorsalic and the lateral thoracic arteries on a rat's lateral thorax and abdomen. The flap was stained by methylene blue and filled with emulsion. The diameters of the anastomotic branches within the flap were measured at different times. The volumes of blood flow on different points of the flap were observed quantitatively by means of ECT scanning. The vitality of the flap was also observed.Our experiment proved that anastomotic branches between blood vessels are the anatomic bases for extra-territorial flap. Blood flows from one blood vessel supplying zone to another through the anastomotic branches between the blood vessels. After the flap formed, The diameters of its anastomotic branches would grow larger.Since 1988, we have designed 33 extra-territorial flaps on cervicothorac area. The flaps have survived well. Our present experiment provided the flap with theoretical evidence that an extraterritorial flap can be devised provided that there is abundant anastomosis between the two axial blood vessels.

Objective To investigate the treatment methods of tissue defects in nose and lower eyelid area.Methods Based on the impaired area,combined pre-expansion of forehead and facial region was adopted.The volume of soft tissue expander was determined.150-170 ml expander was implanted between frontalis muscle and periosteum of forehead,while at the facial region,and the volume of expander should be determined by the normal skin area as large as possible.The excision of impaired tissue was performed after sufficient expansion,and then skin flap or transposition skin flap were advanced at the facial region.At forehead,ortho-position skin flap based on supratrochlear vessels was designed for repairing the nose and palpebra inferior region.Three weeks later division of the ortho-position skin flap was carried out.With the flattened pedicle,the rest part of impaired area was replaced.Results Six cases were performed with this method.For all the cases,the survival rate of flap was 100％.Esthetic appearance and satisfying color-match were achieved,without appearance of lower eyelid ectropion.Conclusions Combined pre-expansion of forehead and facial region is an ideal method in treatment of the defects in nose and lower eyelid area.

OBJECTIVETo investigate the clinical application of expanded flap based on cutaneous branch of transverse cervical artery for reconstruction of cervical cicatricial contracture.

METHODSBased on the clinical anatomy of cutaneous branch of transverse cervical artery flap, we design the corresponding subclavicular area for expansion. The incision was usually located at the anterior axillary fold, 5-8 cm in length. The expander was implanted under the deep fascial layer, without injury of the vascular pedicle. Fixation sutures were put about 1 cm apart from the incision to prevent the expander from transposition and exposure. After expansion, the cervical cicatricial contracture was excised and released. According to the defect, the expanded flap based on the cutaneous branch of transverse cervical artery was designed, with the pedicle located at the posterior margin of sternocleidomastoid and 1. 8 cm above median point of clavicle. "S" shape incision was made at the location of vascular pedicle. Subcutaneous dissection was performed 1.5 cm in width along the incision on both sides. Then the flap was harvested under the deep fascial layer and rotated to cover defect without tension. It was not necessary to dissect the vascular pedicle further. The defect at donor site was closed directly.

RESULTS17 cases were treated with the island flap. The contracture of the cervical scar was corrected completely with aesthetic appearance.

CONCLUSIONSExpanded flap based on cutaneous branch of transverse cervical artery has reliable blood supply. It' s an ideal flap for the treatment of cervical cicatricial contracture.

Arteries ; Cicatrix ; surgery ; Clavicle ; Contracture ; surgery ; Dissection ; methods ; Fasciotomy ; Humans ; Neck ; blood supply ; Neck Muscles ; anatomy & histology ; Surgical Flaps ; blood supply

Objective To discuss the repairing methods of the wound after upper lip lesion excision.Methods The wound after upper lip lesion excision was repaired by expanded pedicled submental flap.The 3 cm-long incision was located in 1 cm to sub-mandible.The 100 ml expander was placed beneath the platysma,and the aqueducts and spigots of the expanders were laid out of the skin.After complete expansion,the spastic scars of the upper lip and nasal bottom were resolved,the nasal columella and upper lip were put back to the normal position.The pedicled submental flap was transferred to the wound after upperlip excision according to the size of the wound.The pedicle was severed after 3 weeks.Results There were 5 cases of the expanded pedicled submental flap to repair the wound after upper lip excision.The flap survived without complications.The appearances were satisfied by the patients.Conclusions The method of the expanded submental flap is suitable for the wound after upper lip excision.

Objective To explore the method of total nasal reconstruction when the forehead skin for expanding is unavailable.Methods According to the principle of total nasal reconstruction,total nasal scar and deformity were repaired with expanded random forearm falp.All the expanders were placed in flexor side of forearm.The incision sides were placed in proximal,distal,or lateral part of the forearm according to different pedicles.After expansion,the nares were enlarged,eversion of ala nasi corrected,the contracture scars sufficiently released,and the size and shape of the reconstructive nose designed according to face size.The scar of nasal dorsum and capsule of the expanded flap could be used for reconstructing nasal dorsum.Donor sides could be sutured directly,the pedicle could be cut 3 weeks later.Results All the flaps survived with good appearances,and 3 of the 15 cases with proximal,11 with distal,and 1 with lateral pedicle.The effect of distal pedicle group was better than that in proximal and lateral pedicle group because of comfortable posture longer pedicle,and providing more tissue for reconstruction.Conclusions Total nasal reconstruction with expanded random forearm flap is an option when the forehead skin for expanding is unavailable.

Objective To evaluate the reproducibility of macular ganglion cell layer(GCL)measurements with high?resolution spectral domain?optical coherence tomography(SD?OCT)in both normal people and glaucoma patients. Methods In this study,24 normal subjects and 21 glauco?ma patients were prospectively included. Macular GCL thickness in 9 areas defined by Early Treatment Diabetic Retinopathy Study was measured with Spectralis SD?OCT applying posterior pole asymmetry analysis pattern. Within?subject standard deviation(Sw),coefficient of variation(CV) and intraclass correlation coefficient(ICC)in normal subjects and glaucoma patients were assessed. Results In normal subjects,the GCL thick?ness in macular central area was 12.58±2.69μm,the average GCL thickness in inner ring area was 48.87±3.81μm,the average GCL thickness in outer ring area was 37.28±1.75μm,and the GCL thickness mapping in normal subjects was horseshoe?shaped with opening to temporal. In glauco?ma patients,the GCL thickness in central area was 9.57±2.06μm,the average GCL thickness in inner ring area was 34.70±9.67μm,the average GCL thickness in outer ring area was 28.20±5.51μm,and the GCL thickness in every macular area in glaucoma eyes was thinner than that in normal eyes(P<0.001). For measurements of GCL thickness in normal subjects,Sw was 0.46 to 0.87μm,CV was 0.67%to 3.71%,and ICC was 0.904 to 0.977. For measurements of GCL thickness in glaucoma patients,Sw was 0.53 to 1.65μm,CV was 1.18%to 5.75%,and ICC was 0.833 to 0.993. Conclusion Spectralis SD?OCT had an excellent reproducibility for measurements of GCL thickness in both normal people and glaucoma patients, which is a reliable technique for evaluating longitudinal change and follow?up in glaucoma.

Objective To develop new repairing techniques for acquired inferior palpebral region defects. Methods Expanded forehead flaps were used to reconstruct the inferior palpebral defects or post-excision wound surface and the flaps were pedicled with supra-trochlea vessels or ramus frontalis arteriae temporalis superficialis. As for supra-trochlea vessels, contralateral ones were prior to the homolateral ones. The incision site located in the scalp and the major axis of the expander parallel to the forehead. Firstly, the leisions were cut and the subcutaneous tissues loosed to regain the anatomy position of inferior palpebra. Secondly, the expanded flaps were transfered onto the defects by the wound sizes with the supra-trochlea vessels as their pedicles. At last, the pedicles were cut 3 weeks later.For ramus frontalis arteriae temporalis superficialis, the flap was transfered with a subdermal pedicle and the donor site was closed directly. Results There were 10 cases in the present group, 6 for supratrochlea vessels and the 4 others for ramus frontalis arteriae temporalis superficialis. All the flaps survived successfully. 3 cases returned with optimistic outcomes 6 months later. Conclusion The expanded forehead flaps are fit for repairing the inferior palpebral defects, which can successfully avoid ectropion. This technique is very useful for reconstructing the texture of the site of defects.

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 the clinical results of repairing frontal lesions with the combination of the expanded scalp flaps and postoperative laser hair removal.Methods There were 10 patients involved between May 2014 through May 2016 in our department.In the first stage,the expanders were implanted to the pockets under the scalp.In the second stage,the wounds,after lesion removal,were covered by the expanded scalp flaps.In the third stage,laser hair removal was performed 2 weeks postoperatively for 4 to 6 times until complete removing the hair.Results All the lesions were repaired with good results.The incisions healed primarily.The scalp flaps survived without nec rosis.The hair on the flap was removed completely.The color and texture of the flap were similar to these of the adjacent skin.The satisfactory results of the appearance were achieved in all the patients.Conclusions The combination of the expanded scalp flap and laser hair removal is an effective method for the repairing of the frontal lesion.

Objective To investigate the application of the frontal branch of superficial temporal vessels pedicled flap in repairing lower eyelid ectropion.Methods Eight cases were collected from patients diagnosed with lower eyelid ectropion in our hospital from April 2012 to April 2015.In phase 1 of operation,the dilators were implanted into the frontal branch of superficial temporal vessels and fully expanded by normal saline injection;In phase 2,the scar of lower eyelid was incised,and the expanded forehead flaps were transferred to cover the wound after the lower eyelid released back to normal anatomy location;In phase 3,the flap delay operation was manipulated 3 weeks after phase 2,and the left wound after scar excision was finished by pedicle division 1 week later.Results All patients in the study showed a good appearance and function of lower eyelid.There were no complications such as flap congestion and necrosis occurred.Meantime there were no relapses observed according to the follow-ups ranging from 6 months to 1 year.Conclusions The application of the frontal branch of superficial temporal vessels pedicled flap shows a promising procedure in treatment of lower eyelid ectropion.