Objective To summarize the clinical effect and experience of vacuum sealing drainage ( VSD) technology combined with sural neurovascular flap to repair chronic and infection soft tissue defects in the foot and ankle?Methods From 2010 to 2015, the clinical effect of 58 cases patients who were treated negative pressure drainage combined with sural nerve nutrient vessel flap for repairing foot and ankle chronically infected wounds in Zhongnan Hospital of Wuhan University were retrospective analyzed?All cases were treated by debridement,negative pressure suction 1, 2 times, cleaning the wound, Wound secretions were negative after culture,then cut and take the nutrient vessels of the nutrient vessels to repair the wound?Results All flaps survived completely in 58 cases,54 cases inⅠstage healing,postoperative 4 cases were suffered with distal skin flap necrosis,and healed after dressing?The outline and function were satisfactory during 1 to 3 years follow?up?Conclusion The effect of negative pressure drainage combined with sural nerve nutrient vessel flap for repairing chronic wound of foot and ankle is exact, skin flap transposition of the wound should be thoroughly debridement,edge scar tissue should be appropriate resection.

Objective To study retrospectively the results of minute tissue flap for repairing tissue defect of hand. Methods The transposition or transplantation of ten kinds of tissue flaps were applied to repair skin or bone or joint defect of hand in 102 cases. Results The period of follow-up was one to eighteen years. All skin flaps were live and appearance is excellent. The function of hand is good. The period of bone healing was three to four months and joint motion is satisfactory' Conclusions Microsurgical repair of skin defects of hand have shorter period and good results' Skin defect with naked bone and joint or tendon in hand should apply minute skin flap to repair in onestage. Various vascularized minute bone flaps may be choiced to repair non-union of scaphoideum or lunatum necrosis and metacarpal head defect.

Objective To provide applied anatomic bases for the transplantation of scapular spine bone flap pedicled with supraspinous branch of suprascapular artery Methods The origin,course,branches and distribution were observed on 30 adult cadaver specimens;the operative designs were imitated on 6 specimens Results The supraspinous branch originated from suprascapular artery,went between supraspinatus muscle and scapular bone medially,and divided into 3～4 periosteal branches to scapular spine with a diameter of 0 5～0 8mm The length of stem of supraspinous branch was (4 8?0 6)cm Conclusions The transplantation of scapular spine bone flap pedicled with supraspinous branch of suprascapular artery is feasible

Objective The clinical results of leukemia improved significantly due to the application of arsenic trioxide(As 2 O 3 ).This compound was used in inducing apoptosis on osteosarcoma cell lines and its mech anism was explored.Methods Human osteosarcoma MG-63cell line was cultured and treated with0.25,0.5,1,2,4and8?mol/L As 2 O 3 .The cell line was measured at24,48,72,96and120h after As 2 O 3 infiltration.MTT assay,phase contrast light microscopy,fluorescence staining,TUNEL,flow cytometry anal-ysis and RT -PCR were used to investigate the inducing apoptosis and inhibitative effect of As 2 O 3 on os-teosarcoma MG-63cell line.Results As 2 O 3 could inhibit the reproduction of osteosarcoma cell line MG-63significantly,the inhibitive rates of MG-63cell line treated with As 2 O 3 over1?mol/L reached70%.Un -der phase contrast light microscopy and fluorescence staining,osteosarcoma cells cultured with As 2 O 3 pre sent -ed typical apoptotic changes.The majority of cells cultured with As 2 O 3 were positive with TUNEL.Flow cy tometry analysis showed a time-dose dependent apoptosis rate and a remarkable G 2 /M phase arrest.The ex pression of c-myc was decreased in MG-63cells treated with As 2 O 3 .Conclusion As 2 O 3 is able to in duce osteosarcoma apoptosis effectively.The expression of decreasing c-myc is an important mechanism in induc-ing osteosarcoma MG-63cells apoptosis.

Objective TNF-related apoptosis-inducing ligand(TRAIL)was a new member of TNF family.It could quickly inactivate tumor cell originated from different tissues but no effects on normal tissue in vitro.Osteosarcoma was the most common primary malignant bone tumor with the survival rate of 5years no more than20%after simple surgical management.The induced apoptosis and selective cytotoxicity of human soluble TRAIL for MG -63cell line were investigated in order to explore the feasibility of sTRAIL in clinical treatment of osteosarcoma.Methods sTRAIL-mediated cytotoxicity by MTT assay in MG-63osteosarcoma cell line,MRC-5human diploid lung cell line and L-02fetus hepar cell line were assessed,apoptotic cellular morphological transformation by phase contrast microscope and electron micro-scope was observed.The expression of TRAIL receptors mRNA in the cell lines was examined by RT -PCR.The apoptotic rates of MG-63cell line were shown by flow cytometry.Moreover,the apoptosis of MG-63cell line induced by sTRAIL was confirmed by terminal-deoxynucleotidyl transferase mediated nick end labeling(TUNEL).Results MG-63,MRC-5and L-02cell lines were treated for 24hours with dif ferent concentrations of sTRAIL and the inhibitive rates of sTRAIL were evaluated with MTT assay,the in hibitive rates of 500ng /ml,1?g /ml ,2?g /ml and5?g /ml TRAIL inducing MG-63osteosarcoma cell line were10.1%,24.3%,50.6%and more than95%respectively.By flow cytometry,an obvious apoptosis peak ahead the diploid peak was obtained when MG-63cell line incubating with2?g/ml TRAIL for 6hours,howev er,the consequences of MRC-5and L-02cell line were non-differentiated.Therefore,MG-63cell line was significantly sensitive to sTRAIL-mediated apoptosis,but MRC-5and L-02cell line were resistant to sTRAIL-induced cell death.Under phase contrast microscope,when MG-63cell line were treated by sTRAIL,some cells began to became small and round in3to8hours.In24hours a large number of cells exfoliated and drifted in culture medium.Moreover,karyopyknosis and crescent aggregation of chro-matin were observed by electron microscope.By RT-PCR,the expression of TRAIL-R1,R2and R3but not R4mRNA on MG -63and MRC -5cell line were observed,and there were the expression of TRAIL-R1,R2,R3and R4mRNA on L-02cell line.In TUNEL assay,the nucleus of the apoptotic cells became brown or yellow.Conclusion TRAIL is able quickly to kill MG-63osteosarcoma cell line in vit-ro.Fur thermore,TRAIL is non significant cy-totoxic for normal tissue.TRAIL or TRAIL com bined with chemotherapy and radiotherapy is a potential and valuable proposal for clinical treatment of osteosarcoma.

Objective To observe the curative effect of the treatment of serious femoral neck fractures with vascularized great trochanter bone flap transposition in young adults.Methods Twenty-nine cases were investigated.In which Garden type Ⅲ were 10 and type IV 19.There were 12 ca$,e8 of fresh fractures and 17 old fractures.According to the X-ray films of old fractures,caput femoris necrosis occurred in 7 patients.Tibial tubercle traction was carried out as preoperative preparation as soon as the patients were sent to hospital.The operation was performed by combining hollow-lag-svcrews fixing with vascularized great trochanter bone flap transposition.Results The foUow-up lasted 39 to 84 months,with an average of 54 months.The patients suffering from fresh femoral neck fractures all recovered and no necrosis WaS found.The healing time was between 4 to 6 months,with an average of 4.5 months or so.And old fractures were all healed up almost within the same time.The recovery time of patients who suffered from fractures and necrosis was with an average of 12.5 months.Of 10 cases of old fractures without caput femoris necrosis prior to operation,necrosis occurred in 3 c88es.The functions of hip joints of 15 cases completely recoveTed,and 12 patients were partially restricted.Another 2 patients could not squat because the flexion function was seriously restricted.The crispation of limbs was well corrected.According to Harris standard.the postoperative mean SCOre is 89.2.Concision It is good for treatment of serious femoral neck fractures with vascularized great trochanter bone flap transposition in young adults.

Objective To discuss the clinical value of transposition of the pedicled anterolateral femoral periosteal flap. Methods The blood supply of anterolateral femoral periosteum were dissected on 38 adult cadaveric lower limber specimens injected with red dye. The origins, distributions and anastomosis of periosteal breanches were observed and measured. Based on these anatomic investigations, the transposition of pedicled anterolateral femoral periosteal flap was designed to repair the bone nonunion and lesion of femur. Results Twenty-two cases were treated in the satisfactory results, and followed-up from 1 to 5 years. The size of the periosteal flap ranged from 8cm?4cm to 10cm?5cm. Conclusions The periosteal flap could be operated so conveniently and safely as to be spread easily, treatment of lesion and incision of periosteal flap can be finished in the same operative approach. The periosteal flap have been proved to be powerfully clinical value.

ObjectiveTo observe the curative effect of Gustilo typeⅢ fracture with soft tissue defect of leg in children.MethodsOf the 15 patients,the area of the soft tissue defect varied from 5 cm × 6 cm to 8 cm × 12 cm.With regard to the location of soft tissue defect,two were situated at the upper third of the leg,eight were middle part of the leg,four were lower portion of the leg and dorsum of foot,one was lower portion of the leg and heel.The fracture was fixed by external fixation device and raw surface was closed by negative pressure drainage in the first stage.The raw surface was eventually covered by the transposition of regional flap or cross leg flap in the second stage.Among them,three patients underwent transposition of saphenous neuro-veno-fasciocutaneous flap, three patients underwent sural neuro-veno-fasciocutaneous flap transposition,one case of medial head of gastrocnemius muscle flap and 7 cases of cross leg flap were performed,while only 1 patient underwent free lateral anterior thigh flap transposition.ResultsOne patient who underwent transposition of saphenous neuro-veno-fasciocutaneous flap present with necrosis of the distal end of the flap 5 days after operation,which was then cured by cross leg saphenous neuro-veno-fasciocutaneous flap.Dark crust in distal end of flap occurred in 1 patient who underwent sural neuro-veno-fasciocutaneous flap,which was cured by changing dressings.Bone fracture of 14 patients were all healed.One patient who was classified as Gustilo Ⅲ c underwent cross leg flap, but bone defect was produced 18 months later.Through 3 months to 2 years follow-up,the texture,colour and shape of flap is good. ConclusionWith regard to Gustilo type Ⅲ fracture combined with soft tissue defect of leg in children,external fixation coupled with flap transposition can cure effectively.

Objective To provide an anatomical basis for repairing the defect of cervical tracheal wall with vascularized pectoralis major tendon flaps.Methods Thirty-two lateral thoracic necrotomies were studied for the following aspects.Measurement of pectoralis major tendons' length,width and thickness.Anatomy of thoracoacromialartery,pectoral branches:origin,distribution.Measurement of length of pedicle,rotated radius of flaps and length from recipient site.An imitative operation was undergone on a specimen of corpse.One patient was undergone the operation of repairing the 3.0 cm × 1.5 cm defect of anterior cervical trachea wall,accompanying with incision infection,with pectoralis major tendon flap.Results Length of pectoralis major tendon:(22.9 ± 0.9)mm.Width of tendon:(51.0± 2.4)mm.Thickness of tendon:(5.81± 1.35)mm.Length of pedicle:(89.3 ± 5.3) mm.The radius of pedicle pectoralis major myotendinous flap:(121.7± 8.2)mm.The distance from pivot point of flap to central point of recipient:(96.5 ± 8.9)mm.Patient possessed normal pronunciation,good appearance and no emphysema at 5 months' follow-up.Tracheal lumen,measured 2.6 cm in the anteroposterior dimension and 1.8 cm in the lateral dimension,showed no recurrence of obvious stenosis in cervical computed tomography at 3 month postoperatively.Conclusion Pedicle pectoralis major tendon flaps,originated from thoracoacromial artery pectoral branches can repair cervical tracheal wall defects effectively.

Objective To explore indications for replantation and amputation of complex severed lower legs. Methods Fifteen lower legs in 25 cases with complex severed lower limbs were replanted including four finally amputated again, and other 10 legs were amputated directly after trauma. Those with successful replantation were repaired with microsurgical technology and limb lengthening procedure for complications such as soft tissue defect, bone defect and limb shortening. The amputated cases were fitted with prosthetic limb after wound healing. Results All cases were followed-up for three to 10 years (6.4 years in average), and 11 lower legs were survived in 15 replanted cases and other four were finally amputated and fitted with prosthetic replacement. The limbs of those with successfully replantation shortened to varied extent, and one can be categorized as grade Ⅰ, four as grade Ⅱ, four as grade Ⅲ and two as grade Ⅳ, according to Chen's classification of function evaluation for replanted limbs. Appearance of prosthetic limbs in 14 cases had no significant difference from the normal, and 12 of them could walk with load and two had slight claudication. Those with prosthetic limbs were more satisfactory than those with replantation of the limbs. Conclusion Replantation for complex severed lower legs should be comprehensively considered based on mangled extremity severity score (MESS), their local condition and function prognosis.