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Objective:To investigate the effect of ionizing radiation on the ferroptosis of skin cells and the potential therapeutic strategy of ferroptosis inhibitor Ferrostatin-1 (Fer-1) on irradiated skin cells.Methods:HaCaT cells were pre-treated with Fer-1 before X-ray irradiation. After irradiation, CCK-8 assay and LDH release assay were used to detect cell viability and cell death, flow cytometry was used to detect the lipid peroxidation levels, crystal violet staining assay was used to detect colony forming ability, and the expressions of ferroptosis related proteins ACSL4 and GPX4 were detected by Western blot.Results:The cell viability of HaCaT cells was significantly decreased ( t=5.63, 8.74, P<0.05) and the release of LDH was significantly increased ( t=3.98, 5.08, 9.27, P<0.05) after different doses of X-ray irradiation. The cell viability was improved ( t=5.79, P<0.05) and the release of LDH was reduced ( t=12.36, 11.96, 18.13, 9.96, P<0.05) after the pre-treatment with Fer-1. The lipid peroxidation levels of HaCaT cells were significantly increased ( t=9.59, P<0.05) and the clonogenic survival ability were reduced ( t=4.26, P<0.05) after 10 Gy X-ray irradiation, while Fer-1 pre-treatment reduced ( t=6.48, 17.04, P<0.05) the increase of lipid peroxidation level induced by X-ray irradiation and also effectively restore ( t=3.96, P<0.05) the clonogenic survival ability. The expressions of ACSL4 and GPX4 were decreased after 10 Gy X-ray irradiation, while they recovered to normal level ( t=5.23, 7.16, 4.78, 8.29, 6.43, P<0.05) after the pre-treatment with Fer-1. Conclusions:Ferroptosis inhibitor Fer-1 alleviates the progress of radiation-induced skin injury by inhibiting ferroptosis after ionizing radiation at the cellular level, which provides a potential strategy for the protection of radiation injury.
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Objective:To investigate radiation-induced somatic mutations and variations and provide theoretical basis for clarifying radiation-induced genetic changes and long-term effects by whole-genome sequencing analysis of the genetic variations of the victim of the " 5.7" 192Ir radiation accident in Nanjing. Methods:Normal back skin tissue, irradiated bone and soft tissues, and peripheral blood were collected from the victim 2 047 days post-irradiation. DNA of these samples was extracted and sequenced with high-throughput genomics and analyzed by bioinformatics method. The genetic variations of between irradiated and normal tissues were compared.Results:Compared with normal back skin tissue, there are large amounts of genetic variations in the irradiated bone and soft tissues and peripheral blood, including base substitution (transition, transversion), small insertion, small deletion, copy number variation (gain, loss) and structure variation (large deletion, large duplication, inversion, intra-chromosomal translocation, inter-chromosomal translocation). There were 10 666 genetic variations in the irradiated bone and soft tissues and 11 233 genetic variations in peripheral blood, where thousands of genes were involved in. These variations occurred in the exons, introns, UTR′3, UTR′5, splicing sites, within 5 kb upstream of transcription initiation site, within 5 kb downstream of transcription termination site, ncRNA and intergenic region. All chromosomes had genetic variations.Conclusions:There were a large number of genetic variations in the irradiated tissues and blood of the victim at 2 047 days after irradiation, which may affect the body function and cause the long-term effects.
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Objective@#To introduce the application of free-style perforator flap based on aesthetic units to repair facial defect after tumor resection.@*Methods@#By following the concept of free-style perforator flap and the principle of facial aesthetic unit, the design of a free-style perforator flap allowed over any nearby cutaneous vessel chosen purely on the characteristics of its Doppler signal. Conventional knowledge of anatomical landmarks and possible vascular variations were less relevant. A greater freedom in flap selection was gained to recover defect in different forms such as rotation flap, advanced flap and propeller flap, which were all based on free-style perforators. The flap size ranged from 1.5 cm×1.0 cm to 12.0 cm×6.0 cm with the perforator diameter of 0.3-3.0 mm in pedicle, and some of the pedicles are "perforator clusters" .@*Results@#A total of 72 cases underwent surgery, and 68 cases survived completely with satisfactory appearance. 1 case healed two weeks later through dressing due to undesired healing, which result ed from high tension secondary postoperative blooding. 3 cases healed in a delay due to congestion and gained acupuncture treat.@*Conclusions@#The free-style perforator flap, which depended on Doppler-discerned perforator and facial aesthetic unit, represents safe, reliable and versatile for repairing facial defect after extended resection, and it not only offers a greater freedom in flap selection but also provides good aesthetic result.
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Objective@#To evaluate the parabiotic tissue protection concept in the repairment of acute radiation-induced skin injury.@*Methods@#Seven patients(3 males and 4 females) with acute radiation injury treated in the Department of Plastic Surgery of the Second Affiliated Hospital of Soochow University from February 2014 to January 2018. The ages of patients ranged from 45 to 76 years. The wound areas include perineum and buttock (n=3), chest(n=2), and thigh(n=2). In the early stage, subregional " sandwich" surgical dressing was used to protect the probiotic tissue. Two months later, the necrotic tissue was clearly demarcated, the debridement was underwent, and the parabiotic tissue was preserved as far as possible. Vacuum sealing drainage(VSD)was applied to cover and soak wound with normal saline to moisturize the wound and promote the benign transformation of ecological tissue. Ten days later, the granulation grown well, and the skin flaps and myocutaneous flaps with good blood supply were designed to repair the wounds. The VSD device was continued to be used, to drain effusion under flap and promote the growth of cystic cavity granulation, with the purpose to promote blood supply of the skin flap, perform the final biological cleaning effect on the parabiotic tissue of the wound surface, promote the benign transformation of parabiotic tissue, and reduce the further necrosis.@*Results@#Seven patients with Ⅳ degree acute radiation-induced injury wounds were treated 6-10 weeks for surgery preparation, and 2-4 weeks for VSD-application after debridement. Except for part of flap was necrotized on 10th day after the first operation in one patient, all the other patients achieved satisfied outcome in a surgery. There was no further radiation-induced ulcer occurred during the 0.5-3 years of follow-up.@*Conclusions@#The concept of parabiotic tissue protection during preoperative, intraoperative and postoperative recovery phase can promote parabiotic tissue transformed to a good result after acute radiation injury, and reduce the size and depth of soft tissue necrosis, which can provide a good foundation for the secondary repair with flap and reduce complications.
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Objective To explore the clinical significance of protection "Choke vessel area" in the application of perforator flap to repair large defect of trunk after tumor resection.Methods A total of 62 patients (38 males and 24 females,aged from 19 to 79 years) from the Department of Plastic Surgery,Second Affiliated Hospital of Suzhou University underwent reconstructive surgery for large area defects of the trunk from March 2012 to January 2016.The perforator flap was designed according to the perforator location detected by Doppler before surgery.The flaps were harvested on the pedicle of perforators and dissected on the deep layer of deep fascia (including part of the myolemma).The areas of flap ranged from 5.0 cm × 10.0 cm to 19.0 cm × 22.0 cm.The donor site was sutured directly or local flap was transferred to repair.Results Flaps survived well in 59 of the 62 cases.The tip of flap was necrotic and healed after dressing change in 1 diabetic patient.The distal part of flap was necrotic on cuticular layer and healed after dressing change in another patient with scrotal defect.One patient had flap necrosis 10 days after operation and was repaired twice.The results were satisfied after following-up from 3 months to 2 years for 17 cases and from 6 months to 2 years for 25 cases.Fibrosarcoma protuberant and squamous cell carcinoma recurred in 1 case each,but the function and appearance were satisfactory after primary repair.Conclusions The procedure of preserving Choke vessel area can improve the blood supply of perforator flap and obtain larger survival area and survival quality.It is worthy of clinical application.
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Objective@#To analyze effects of cooperation between physicians in department of burn surgery and department of intensive care medicine on rescue and treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident.@*Methods@#On August 2nd, 2014, 15 extremely severe burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident were admitted to temporary burn treatment center established in Department of Critical Care Medicine of the Second Affiliated Hospital of Soochow University. The 15 patients were equally divided into 3 groups, with 5 patients in each group. Fifteen surgeons and 30 nurses from department of burn surgery and 15 physicians and 30 nurses from department of intensive care medicine from different hospitals in China were divided into 3 groups, with 5 physicians and 10 nurses from department of burn surgery and 5 physicians and 10 nurses from department of intensive care medicine in each group. Each group of physicians and nurses were responsible for treatment of 5 patients. Treatment of patients was leaded by surgeons from department of burn surgery, who were responsible for wound dealing and operation. Physicians from department of intensive care medicine were responsible for systemic treatment and adjustment of relevant equipment's parameters. Volume of fluid infusion and urine output in shock period, severe systemic complication during period of treatment, using time and kind of antibiotics, death in 1 month after admission, length of hospital stay, and survival of patients were monitored.@*Results@#Volume of fluid infusion of 15 extremely severe burn patients within the first 24 hours post injury was 10 360-17 162 (12 998±1 811) mL, including (1.62±0.23) mL·% total body surface area (TBSA)-1·kg-1 electrolyte and colloid and (2 850±232) mL glucose, with electrolyte and colloid ratio of (1.76±0.23)∶1.00. Volume of urine output within the first 24 hours post injury was (2 384±1 242) mL, with (99±52) mL in each hour. Volume of fluid infusion of 15 extremely severe burn patients within the second 24 hours post injury was 8 720-11 616 (9 406±1 277) mL, including (1.04±0.22) mL·%TBSA-1·kg-1 electrolyte and colloid and (2 910±187) mL glucose, with electrolyte and colloid ratio of (1.53±0.31)∶1.00. Volume of urine output within the second 24 hours post injury of patients was (2 299±1 362) mL , with (108±61) mL in each hour. One patient had pulmonary infection, and 7 patients had fungal infection, and no patient had gut microbiota dysbiosis. Patients were treated with combined 2 kinds of antibiotics for 21-85 (50±16) d. No patient died within 1 month after admission. The length of hospital stay was 53-132 (98±44) d. Ten patients survived finally.@*Conclusions@#After being treated by cooperation between physicians in department of burn surgery and department of intensive care medicine, severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident had hemodynamic stability and could stably experience shock period, with less complication, shorter length of hospital stay, no death within 1 month after admission, more survived patients, which can provide reference for rescue and treatment of severe mass burn patients.
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Objective To study the value of free-style perforator flap in repairing nasal defects after tumor resection.Methods On the basis of the guidance of free-style perforator flap design concept and the foundation of vascular localization by Doppler based on the ultrasonic echo intensity,combined with nasal beauty subunits,we designed free-style perforator flap in different forms such as V-Y advancing flap,rotating flap,and propeller flap,which had with free-style perforator in pedicle all.We transplanted the flaps to repair nasal defects after tumor resection.The area of the flaps was between 2 cm x 1.0 cm and 8.0 cm x 5.0 cm,and the diameter of the perforate vessel in the pedicle of flap was between 0.3 mm-3 mm,and some of the pedicles were composed of perforate vessel tube bundle.In order to reduce recurrence rate,the radiotherapy was performed according to the pathology in 1 month after surgery.Results In 31 cases of this group,29 cases were performed and the postoperative shape was good.1 case appeared postoperative hemorrhage,and the epidermis of flap formed blister because of greater tension,and the patient healed 10 days later after extraction the bubble fluid and changing medicine.The flap of 1 case was silted because the venous was blocked,and the acupuncture was treated,and then the flap got delayed union.23 cases received adjuvant radio therapy after surgery and fellowed up from 6 months to 5 years,showing that local profile and color were satisfacfory without tumor recurrence.Conclusions It is worthy of clinical promotion to designing freetype perforator flap and to repair defect after extensive nasal tumor resection on the basis of beauty subunits in nasal and vascular anatomy,which can not only reduce the recurrence rate by postoperative radiotherapy in time,but also realize better cosmetic requirements.
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METHODS: Between October 2006 and December 2014, 9 patients with serious dog bite wound were treated. There were 3 males and 6 females with an average age of 34.5 years (range, 8-68 years), and with a mean disease duration of 4 hours (range, 30 minutes to 24 hours). The defect ranged from 1.7 cm×0.5 cm to 15.0 cm×8.0 cm, with the mean depth of 0.5 cm (range, 0.3-0.8 cm). Deep tissue exposure was observed. After routine debridement, a vacuum sealing drainage (VSD) was equipped to suck and irrigate for 1 day, then wound was repaired. The superomedial edge of defect was trimmed, then a GBL shape mainly with square and rectangular was designed. According to defect size, a double pedicled flap was designed at the lateroinferior edge of defect, which size ranged from 1.7 cm×1.5 cm to 18.0 cm×15.0 cm. The donor site was sutured directly. VSD was used for 3 days after operation.
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Objective To observe the effect of recombinant human growth hormone on flap survival and angiogenesis through preoperative local subcutaneous continuous injection of rhGH in narrow pedicle flap.Methods 40 rats were divided into two groups at random,named as groups Ⅰ and Ⅱ,20 rats each.A narrow pedicle flap was designed on the left back of rat in groups Ⅰ and Ⅱ.Then group Ⅰ was subcutaneously injected with rhGH [0.4 IU/(kg · d)] for 3 days.Another group did not have any injection.After 3 days,we established a model of narrow pedicle flaps in the left back of animals.After operation,the flaps of groups Ⅰ and Ⅱ were injected with rhGH [0.4 IU/(kg · d)]for 7 days.The survival percentage of the flap was calculated at 7'th day.Specimens were collected at the diffent point of time.Expression of VEGF,CD34 was detected by immunohistochemistry and ELISA.The MVD of the flaps was also calculated.Results According to the 7 days' observation after the surgery,the percentage of flap survival area for groups Ⅰ and Ⅱ was (100.00±0.00)％,and (94.00±1.10)％ (P＜0.05).The expression of VEGF,CD34 and the MVD values of group Ⅰ was higher than that of group Ⅱ at the same point of time (P＜0.05),especially on the day of surgery.Conclusions Preoperative and local subcutaneaous continuous injection of rhGH on flaps can enhance the expression of VEGF and CD34 and microvascular formation,mitigate the damage of ischemia and hypoxia to flap during the postoperative period,and therefore improve the survival of narrow pedicle flap.
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Objective To probe into the application of vacuum sealing drainage (VSD) in flap with slender narrow pedicle and to observe the survival,the shaping of blood vessel,congested edema and the expression of CD34 in the flap,and to analyze the underlying mechanism of VSD on the flap survival.Methods 64 SD rats were randomly divided into 8 groups:4-hour group,8-hour group,1-day group,2-day group,3-day group,4-day group,and 6-day group.A flap was designed and put on either side of a rat's back.The both width and length of the flap were 0.8 cm and the pedicle sized in the diameter of 3.5 cm.Both sides of the flaps on the rats' backs were randomly arranged into control side and experimental side.VSD was fixed sideways to each group after the shaping of flaps.Each of the equipments was dismantled respectively in the corresponding time after the operation.Afterwards the color and swelling degree of the flaps were observed,a sample was cut and the flap survival area was measured altogether on the 7th day.Flap histology and the expression of CD34 were observed mainly through HE dyeing and immunohistochemistry.The statistical data were treated to figure out the flap survival rate and to determine whether statistical differences existed in the microvessel density (MVD).Results As the time of the negative pressure suction went on,the survival area of the experimental side flap was increasing day by day and came to the maximum on the third day (95±4)％,but no statistical difference was discerned between on the third day and on the sixth day (P＞0.05).As the time of the negative pressure suction went on,the MVD in the flap was also increasing.Statistical differences (P＜0.05) existed between the experimental side of the instant group,4-hour group and the 8-hour group and those of 3-day group,4-day group,and 6-day group.Conclusions The application of VSD can advance the survival of the flap,whose survival area can reach its maximum within 3 days under application.Besides,it can promote the increase of MVD in the flap.
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Objective To investigate the effect of recombinant human growth hormone on the PingPang Racket flap survival.Methods Every two PingPang Racket flaps were designed on the both sides of 40 adult SD rats's back.The pedicle size was 1.0 cm × 1.0 cm,while the flap size was 3.0 cm in diameter circular.Longitudinal axis of flap was perpendicular to the center line of the rats back,to which the distance from proximal pedicle was about 1 cm.The flaps on the left side served as Ⅰ group,and the other side served as Ⅱ group,which were subdivided into Ⅰa and Ⅰb,Ⅱa and Ⅱb,respectively.And there were 20 rats in each subgroup.On the flap surfaces in group Ⅰ,it was 6 uniform injection poinsts,subcutaneously injecting with rhGF (the dose was 0.1IU · Kg-1 · d-1) for 7 days from the beginning of operation,that were designed.It goes the same way to the group Ⅱ,while normal saline was instead of rhGF.In subgroup Ⅰa and Ⅱa,the flaps were generally observed every day.The percentage of the flap survival area was determinated 7 days after operation.In subgroup Ⅰb and Ⅱb,specimens were collected at the distal end of flap at intraoperative(before injecting rhGF)and 1 st,3rd,5th,7th day after operation.Immunohistochemistry and enzyme-linked immunosorbent were applied to examine the expression of TGF-β1 and CD34,and the microvessel density of the flaps was calculated.Results According to the 7 days' observation after the surgery,the flap survival area percentage of subgroup Ⅰa was (97.00 + 2.12) ％,which was significantly higher (P ＜ 0.05) than that of subgroup Ⅱ a,whose was (81.00 +3.43)％.On 1st,3rd,5th and 7th day postoperatively,the expression of TGF-β1,CD34 in both subgroup Ⅰb and Ⅱb were elevated and reached peak on the 5th day.Content of GF-β1 and CD34 in Ⅰb were 1571.40 ± 13.32 pg/ml and 60.40 ±0.32 pg/ml,respectively,and in Ⅱb were 691.43 ± 11.06 pg/ml and 20.43 ± 0.06 pg/ml.At the same point of time,the expression of TGF-β1,CD34 were significant higher in Ⅰb subgroup than that in Ⅱb (P ＜ 0.05).In subgroup Ⅰb and Ⅱb,the number of microvessels increased on postoperative 1 st,3rd,5th and 7th day,especially on 3rd,5th and tended to be stable at 7th day.At the same point of time,the number of microvessels in Ⅰb was always higher than that in Ⅱb (P ＜ 0.05).Conclusion Subcutaneous injection of rhGH on flaps can enhance the expression of TGF-β1,CD34,promote microvascular generation of the flap tissue directly or indirectly,and also improve the survival of PingPang Racket flaps.
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Objective To discuss the effect of early application of vacuum sealing drainage (VSD) on the small vessels and microthrombus of congested flap.Methods 56 SD rats were randomly divided into 7 groups after operation:one-hour group,four-hour group,one-day group,two-day group,three-day group,four-day group and seven-day group.A flap was designed and put on either side of a rat's back.The flaps were randomly arranged into control group and the flaps on the other side served as the experiment group.The equipment of VSD was fixed to each experiment flap.We observed and measured the flap,survival area,the expression of HIF-1α and vascular endothelial cell and microthrombus on the flap at different time.Results Firstly,the damage of vascular endothelial cell and microthrombus in the experiment flaps was less than the control group of flaps at the same time,so as the expression of HIF-1α.Secondly,the trend of expression of HIF-1α did not rise obviously in first 3 days and rose obviously from the 4th day in the experiment flaps; but in the control flaps,when time-lapse,the expression of HIF-1α increased,reached the plateau level at 6th day.Thirdly,the congestion of experimental flap was mitigated as compared with those under control,and the survival area was bigger,and it reached the top on the third day.Conclusions The application of VSD early to flap can aspirate detained blood initiatively,reduce the ischemic and hypoxic status of the tissue of flaps,and so it can lessen the damage of vascular endothelial cell and the formation of microthrombus of flap,beneficial for the survival of flap.
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ObjectiveTo introduce the application of slender narrow subcutaneous fascia pedicle flap in repairing the cavity of conchs wound in microtia plasty,and to investigate its survival mechanism.MethodsThe all 6 congenital microtia cases were repaired with the concha compound flap up rotation.The all microtia concha wounds were repaired with the slender narrow pedicle.The lateral maxillocevicai fasciotaneous flap with its slender subcutaneous fascia pedlcle located in front of auricle.The size of the flaps ranged from 3.0 cm × 3.0 cm to 4.0 cm × 4.5 cm,The width and length of the pedicle ranged 1.0-1.5 cm and 3.5-4.5 cm.Results6 cases of the slender narrow subcutaneous fascia pedlcle flaps all survived,with primary wound healing and ideal appearance.ConclusionsThis slender narrow subcutaneous fascia pedlcle flap does not contain any major blood vessel,which is dissected easily in the operation.Due to its slender narrow pedicle,the flap rotation is also easy and its coverage area is large,without cat ears.The postoperative appearance (color,lexture,cosmetic aspect)is satisfactory.The slender narrow flap is an extraordinary new design and is ideal for the cavity of concha wound repair in the microtia plasty.
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Objective To investigate the effect of deferasirox on DLL4 expression and angiogenesis in a narrow pedicle and random flap in rats.Methods Twenty SD rats were randomly divided into the deferagirox group and control group.Rats were subjected to deferagirox of 100 mg · kg-1 · d-1 inthe experimental groups,respectively and the same dose saline in the control group for 1 week. In each group,flap were created in the bilateral back of each rats.Ratio of length to width of tissue in the pedicle portion and the flap portion was 1 cm × 1 cm and 3 cm × 3 cm,respectively.The tissue samples were taken from the pedicle and the middle portions of the flap.The DLL4 and CD105 expression was also detected with immunohistochemistry (SABC).Results Compared with control group,whatever in the pedicle portion or the middle portion,there was a significant increase of microvessels marked by CD105 and a significant decrease of flap microvessels stained by DLL4 in the deferagirox group.In both groups,compared with the pedicle portion,there was a significant increase of microvessels marked by CD105 and DLL4 in the the middle portion.Conclusions Deferasirox can in crease the CD105 expression and angiogenesis of the slender narrow pedicle random flap.This process might be related to the inhibition of DLL4 protein expression,which is significant in the notch signaling pathway.
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Objective To study the function of hypoxia mimics of different exposure time of deferasirox in improving the growth of micrangium in a narrow pedicle flap.Methods Fourty male SD rats were divided into 2 groups:experimental group was fed with deferasirox 100 mg/kg per day from 1d,3d,5d and 7d,respectively,before the surgery of transferring the narrow pedicle flap,while control group just fed with saline.After 7 days,the immunohistochemistry,Western blot and quantitative reverse transcription-PCR (qPCR) were performed to examine the expression of CD34.qPCR was used to examine the expression of HIF-1α,VEGF in order to investigate the regulatory effect of deferasirox in improving the growth of micrangium and the distinction among the different exposed time of deferasirox in the narrow pedicle flap.Results The deferasirox group exhibited a marked improvement in flap healing time,and with the increasing administration time of deferasirox,the expression of MVD,HIF-1α and VEGF was improved in each treated group (P＜0.05).Conclusions Deferasirox can induce HIF-1α secretion and increase CD34 expression,and so deferasirox can protect endothelial cells from hypoxic and ischaemic injury.
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Objective To investigate the application and survival mechanism of a long and narrow pedicle flap which was used to repair the tissue defects after removal of tumor in aged patients.Methods The long and narrow pedicle flap was designed with its pedicle located beside wound surface along the pathway of well-known or perforating branch blood vessel to repair the defect caused by removing the tumor in aged patients.The size of the flaps ranged from 3 cm × 4 cm to 10 cm × 12 cm.The length and width of the pedicle ranged 2 - 8 cm and 1.0 - 1.5 cm.Results This flap was used in 17 cases.The flap was survived well in 14 patients,and healed later in other 3 patients because of wrong bandaging in earlier period.Conclusions The capability of bearing ischemia and hypoxia of the flap tissue is stronger after transfer owing to low metabolic rate in the skin tissue in aged patients.The flap is easily survived by repairing the tissue defects after removal of tumors in aged patients with the long and narrow pedicle flap.The pedicle of flap is narrow and long,and the transposition of the narrow pedicle flap is easy.The postoperative appearance is satisfactory.It is an ideal choice for repairing the defect caused by removal of tumor in aged patients.
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Objective To reveal the relationship between NOS,CD34 expression and the flap survival area,and to explore the survival mechanism of narrow strip flap,by designing different skin flaps with a slender narrow pedicle in a certain proportion of length to width on pigs' backs.Methods Five narrow flaps were formed on each side of the five white domestic pigs' back,of which pedicle width length ratio were 2 cm:4 cm,the area of the flaps was 2 cm × 2 cm,3 cm × 3 cm,4 cm ×4 cm,5 cm × 5 cm,and 6 cm × 6 cm,respectively,and named as flaps A,B,C,D,and E in turn.Besides,the flap A was taken as control.After the operation,the flaps were evaluated with general obveration,and NOS and CD34 expression and survival area were analyzed.Results For groups A,B and C flaps,the expression level of NOS and CD34 gradually elevated as the flap increased in size,and flaps completely survived (P＜0.05) ; For flaps in groups D and E,when distal end of flap was partial necrosis,the expression level of NOS and CD34 no longer elevated with the increase of skin flap area,and their expression was relatively constant (P＞0.05).Conclusions The survival area of the skin flaps is not in proportion to the width of its pedicle.Thus there is a maximum survival area of a skin flap carried by slender narrow pedicle in a certain proportion of length to width.
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Objective To detect the expression of SDF-1 and CD34,and MVD changes at slen der narrow pedicle flap of hypoxia and ischemia during the survival process,and to investigate the role of SDF-1 at flap neovascularization.Methods The slender narrow pedicle flaps,which pedicle's length-breadth ratio were 4 ∶ 2,and the flap size of each took an area of 2 cm × 2 cm (group A),3 cm ×3 cm (group B),4 cm × 4 cm (group C),5 cm × 5 cm (group D) and 6 cm × 6 cm (group E),were designed and elevated on each pigs' double dorsum.The flaps were served as a hypoxia/ischemia flap model.The survival area,histologic analysis,SDF-1 and CD34 enzyme-linked immunosorbent assay at the distal flap were evaluated at days 0,3,5,7,and 14 after operation,respectively.Results In the each group of flaps,the expression of SDF-1,CD34 and MVD increased with time,reached the plateau level after 5 days (maximal values of SDF-1:124.80 ± 4.05 ingroup A,137.85 ±3.03 in group B,166.53 ± 2.98 in group C,72.80 ± 2.63 in group D and 62.79 ± 2.20 in group E),7 days ( maximal values of CD34:16.76 ± 0.62,17.60 ± 0.72,18.48 ± 0.55,12.70 ± 0.60,and 11.51 ± 0.70,each group),and 7 days (maximal values of MVD:52.45 ± 2.78,59.34 ± 3.12,61.14 ± 3.35,25.25 ± 3.78,and 24.46 ± 7.46,each group),and then gradually decreased.In the different groups of flaps,when the flap area increased,the expression of SDF-1,CD34 and MVD increased,but the parameters decreased at the area of 5 cm × 5 cm,and the flaps were partial necrosis.Conclusions SDF-1 may play an adjusted role in the survival process of the slender narrow pedicle flap.
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Objective To introduce a new and practical method of treating blepharoptosis with direct suspension of the frontal muscle-fascia improvement. Methods 22 cases of blepharoptosis were corrected by direct suspension of the frontal muscle-fascia in which the dynamia still came from frontal muscle.Through double-fold eyelid incision, the frontal muscle-fascia was dissected from the subcutaneous tissue and a 1.5 cm length incision of the frontal muscle-fascia was cut under the supraorbital margin. And through the incision, the frontal muscle-fascia on the superficies of periosteum was dissected 1.5 cm to the upper margin of orbital, and then the frontal muscle-fascia was pulled down and fixed to the levator muscle aponeurosis directly by mattress sutures, with the tension being adjusted to a moderate degree. Results 22 cases of blepharoptosis were cured by primary healing with this method. The patients were followed up for 3 to 6 months with satisfactory results and no recurrence. Conclusion Compared with the traditional methods,this one may decrease the damage to the upper lid and frontalis area, leaving no risk of damaging the vessels or nerves. The technique is simple and the curative effect is affirmed. It can be used to treat any blepharoptosis patient with normal frontal muscle function.