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.

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 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.

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 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 investigate the cosmetic outcome of treatments for mentalis scars with expanded skin flaps.Methods From the experiences of past 26 cases in our department,we summarised the technique for treating the mentalis scars with expanded skin flaps.For simple mentalis scars or localized inferior facial scars,the mentalis,bottom jaw or facial skin were expanded and the expander kept superior to the neck-jaw angle.Otherwise the expander would only fill the angle and the expanding efficiency was reduced.For severe mentalis,neck or facial scars without extra normal treating skin,expanded deltopectoral flaps were chosen to cover the wound after cicatrectomy with pedicles which were cut 3 weeks later.Results All the local ordistant expanded flaps survived successfully in the 26 cases with optimistic outcomes.Conclusions Application of local or distant expanded flaps is a useful technique for mentalis scars treatment.

Objective To investigate the feasibility of transplantation of mesenchymal stem cell (aisc) into expanion skin. Methods MSCs were isolated from porker's bone marrow and cultured in vitro. Pigs were randomly divided into four groups: Group A was injected with MSCs on the local expansion; Group B was injected with MSCs from ear vein; Group C was planted expander only; Group D was the contronl group. Each side of pig's spinal column was implanted with three expander in groups A, B and C. The same volume of NS was injected at the fixed time, the marked area measured after 7, 14, 28 days of expansion, the difference of those area was compared between groups. The differentiation of BM-MSC was detected by immunofluorescence. Results Flow-cytometric analysis showed that these BMSCs expressed CD90 and CD29 highly but did not express CD34 or CD45. The expansion area (cm2) of groups A, B, C and D was 34.05±0. 92, 31.83±l. 07,30. 10±0.79, and 18. 27±0.25, respectively (P＜0. 01). Immunofluorescence showed that the positive expression rate of CD31, PCNA in groups A and B was higher than that in groups C and D, in which the expression was the highest in group A. Conclusions Allogeneic transplantation of BM-MSC can promote skin expansion and the effect of local transplantation group is most significant.

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.

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.