Construction and verification of a quantitative index system to evaluate the medical and nursing care for the elderly service needs / 中南大学学报(医学版)

OBJECTIVES@#To construct a quantitative index system with the integrated medical and nursing care assessment for the elderly service needs, this system can assess the cost of medical and care services accurately and objectively, so as to provide scientific basis for the allocation of old-age service resources in China.@*METHODS@#Based on the survival needs of the Existence, Relation and Growth theory, an index system is constructed through literature analysis, group discussion, and expert correspondence. Analytic hierarchy process was used to determine the weights of indicators at all levels. The 3-grades service items corresponding to each index were quantified through the measurement of working hours, and the medical and nursing care needs of 624 disabled/demented elderly people over 60 years old in Changsha were investigated to evaluate their reliability and validity.@*RESULTS@#The authoritative coefficients of the 2 rounds of expert correspondence were 88.5% and 88.6%, respectively, and the opinion coordination coefficients were 0.159 and 0.167, respectively. The final quantitative evaluation index system included 4 first-level indicators, 17 second-level indicators, and 105 third-level indicators. The service time of doctor ranged from 6.01 to 22.64 min, the service time of nurses ranged from 0.77 to 24.79 min, and the service time of caregiver ranged from 0.12 to 51.88 min. The Cronbach's αcoefficient was 0.73, the split-half reliability was 0.74, the content validity was 0.93, and the calibration validity was 0.781.@*CONCLUSIONS@#The quantitative evaluation index system of medical and nursing service need for the elderly can be used to accurately evaluate the medical and nursing service need.

Evaluating the Reproducibility of the Walking Test for Intermittent Claudication Associated with Lumbar Spinal Stenosis.

STUDY DESIGN: This is a multicenter, prospective study. PURPOSE: This study aimed to evaluate the reproducibility of the walking test for patients with lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE: Walking test is one of the useful procedures to investigate cauda equina syndrome with lumbar spinal stenosis. One the other hands, there were few studies to investigate the reproducibility of this test. METHODS: In this study, we prospectively examined 70 LSS patients with intermittent claudication symptoms at a multicenter outpatient clinic. A walking test was administered at baseline and week 4 to assess patients' walking distance and lower limb pain and numbness. Immediately after the walking test, patients were asked to use the Visual Analog Scale (VAS) to rate their pain and numbness in the front, back, outside, inside, and hip of the lower legs. The reproducibility of the walking test was evaluated using Cohen's κ analysis and intraclass correlation coefficients (ICCs). Meanwhile, the Swiss Spinal Stenosis (SSS) Questionnaire was used to evaluate the severity of the stenosis. RESULTS: The walking distance ICC at baseline and at week 4 remained unchanged at 0.7, with acceptable interobserver reliabilities for lower limb pain and numbness in both legs. The average VAS score for lower leg pain was 23.2±25.2 mm at baseline and 27.4±28.8 mm at week 4, while the corresponding average VAS score for numbness was 23.4±26.7 mm at baseline and 24.8±25.2 mm at week 4. The ICC score was 0.7 for leg pain and 0.7 for numbness. The mean SSS was 30.2±5.5 at baseline and 29.2±5.2 at week 4, and there was no significant difference in the severity. CONCLUSIONS: The walking test for LSS has acceptable reproducibility.

Manual reduction under general anesthesia and anterior cervical discectomy and fusion for treatment of cervical locked facet dislocation / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of manual reduction under general anesthesia combined with anterior cervical discectomy and fusion (ACDF) in the treatment of lower cervical locked facet dislocation.Methods:Retrospectively analyzed were the data of 53 patients with traumatic single segment dislocation of lower cervical spine combined with single/bilateral facet articular lock who had been admitted to Department of Orthopaedic Spine Surgery, Xiangya Hospital, Central South University from January 2019 to December 2020. There were 36 males and 17 females, aged from 18 to 64 years (average, 45.5 years). All the patients were treated with ACDF under neuroelectrophysiological monitoring. Clinical efficacy was assessed by observing complications and comparing American Spinal Injury Association (ASIA) grading, Modified Japanese Orthopaedic Association (mJOA) scores, neck disability index (NDI) and visual analogue scale (VAS) before and after surgery.Results:All patients were followed up for 16 to 30 months (mean, 24 months). All incisions healed by primary intention with no infection after operation. There were 2 cases of delirium, 9 cases of abdominal distension, 4 cases of lower extremity venous thrombosis, and one case of central diabetes insipidus. Postoperative imaging data showed that all patients achieved sequential reduction of the cervical spine, intervertebral bony fusion, and no internal fixation loosening. The last follow-up showed that the overall improvement rate of ASIA grading of spinal cord function was 84.9% (45/53) compared with the preoperation and that the VAS score (2.0±0.5), mJOA score (13.1±3.1) and NDI index (16.6±5.9) were significantly improved compared with the preoperative values (7.5±1.5, 6.9±3.5, and 37.8±7.8) ( P< 0.05). Conclusion:On the premise of fully assessing the patient's injury status, manual reduction under general anesthesia combined with ACDF is a safe and effective treatment of single-level lower cervical fracture combined with facet dislocation.

Simultaneous 3D Visualization of the Microvascular and Neural Network in Mouse Spinal Cord Using Synchrotron Radiation Micro-Computed Tomography / 神经科学通报·英文版

Effective methods for visualizing neurovascular morphology are essential for understanding the normal spinal cord and the morphological alterations associated with diseases. However, ideal techniques for simultaneously imaging neurovascular structure in a broad region of a specimen are still lacking. In this study, we combined Golgi staining with angiography and synchrotron radiation micro-computed tomography (SRμCT) to visualize the 3D neurovascular network in the mouse spinal cord. Using our method, the 3D neurons, nerve fibers, and vasculature in a broad region could be visualized in the same image at cellular resolution without destructive sectioning. Besides, we found that the 3D morphology of neurons, nerve fiber tracts, and vasculature visualized by SRμCT were highly consistent with that visualized using the histological method. Moreover, the 3D neurovascular structure could be quantitatively evaluated by the combined methodology. The method shown here will be useful in fundamental neuroscience studies.

Simultaneous 3D Visualization of the Microvascular and Neural Network in Mouse Spinal Cord Using Synchrotron Radiation Micro-Computed Tomography / 神经科学通报·英文版

Effective methods for visualizing neurovascular morphology are essential for understanding the normal spinal cord and the morphological alterations associated with diseases. However, ideal techniques for simultaneously imaging neurovascular structure in a broad region of a specimen are still lacking. In this study, we combined Golgi staining with angiography and synchrotron radiation micro-computed tomography (SRμCT) to visualize the 3D neurovascular network in the mouse spinal cord. Using our method, the 3D neurons, nerve fibers, and vasculature in a broad region could be visualized in the same image at cellular resolution without destructive sectioning. Besides, we found that the 3D morphology of neurons, nerve fiber tracts, and vasculature visualized by SRμCT were highly consistent with that visualized using the histological method. Moreover, the 3D neurovascular structure could be quantitatively evaluated by the combined methodology. The method shown here will be useful in fundamental neuroscience studies.

Construction and verification of an intelligent measurement model for diabetic foot ulcer / 中南大学学报(医学版)

OBJECTIVES@#The measurement of diabetic foot ulcers is important for the success in diabetic foot ulcer management. At present, it lacks the accurate and convenient measurement tools in clinical. In recent years, artificial intelligence technology has demonstrated the potential application value in the field of image segmentation and recognition. This study aims to construct an intelligent measurement model of diabetic foot ulcers based on the deep learning method, and to conduct preliminary verification.@*METHODS@#The data of 1 042 diabetic foot ulcers clinical samples were collected. The ulcers and color areas were manually labeled, of which 782 were used as the training data set and 260 as the test data set. The Mask RCNN ulcer tissue color semantic segmentation and RetinaNet scale digital scale target detection were used to build a model. The training data set was input into the model and iterated. The test data set was used to verify the intelligent measurement model.@*RESULTS@#This study established an intelligent measurement model of diabetic foot ulcers based on deep learning. The mean average precision@.5 intersection over union (mAP@.5IOU) of the color region segmentation in the training set and the test set were 87.9% and 63.9%, respectively; the mAP@.5IOU of the ruler scale digital detection in the training set and the test set were 96.5% and 83.4%, respectively. Compared with the manual measurement result of the test sample, the average error of the intelligent measurement result was about 3 mm.@*CONCLUSIONS@#The intelligent measurement model has good accuracy and robustness in measuring the diabetic foot ulcers. Future research can further optimize the model with larger-scale data samples.

Development of hair transplantation / 国际生物医学工程杂志

Hair loss is a common problem encountered by both male and female in social life. A variety of systemic diseases, skin diseases, trauma, etc. can lead to hair loss, but androgenetic alopecia is its main cause. Hair loss can cause a series of influences, such as affecting one's self-esteem and emotional health. Healthy and beautiful hair is very important for a person's external image, and the external image can affect a person's work and life to some extent. Hair transplantation surgery has gradually evolved, and its surgical effect is remarkable. However, hair transplantation technology is still not perfect and still faces many challenges, including the supply of hair, the survival rate of the hair, the length of the operation and the concealment of marks after the operation. In this paper, the current status of hair transplant surgery and some important challenges and possible solutions were discussed.

Association between genetic polymorphism of CYP3A4, CYP2D6 and response to methadone maintenance treatment / 中国感染控制杂志

Objective To explore the association between the genetic polymorphism of CYP3A4,CYP2D6 and response to methadone maintenance treatment(MMT)among heroin-dependent patients.Methods Patients undergoing MMT in 6 MMT clinics were randomly selected,information about general socia-demographic characteristics,drug abuse history,and MMT data of patients were collected,genotypes of peripheral blood CYP3A4 and CYP2D6 polymorphic loci were detected.Results A total of 820 patients were enrolled in the study,210 cases were with good response and 610 cases with poor response to MMT.Difference in age between different response groups was statistically significant(P0.05).Conclusion The association between CYP3A4 rs2242480,CYP2D6 rs16947 and response to MMT has not yet found in heroin-dependent patients.

Early and one-stage posterior-anterior surgery for fresh and severe lower cervical spine fracture and dislocation / 中南大学学报(医学版)

OBJECTIVE@#To explore the clinical value of early and one-stage posterior laminectomy decompression, fracture reconstruction and lateral mess screw fixation combined with anterior cervical corpectomy or discectomy for the treatment of fresh and severe lower cervical spine fracture and dislocation.
@*METHODS@#A total of 156 consecutive cases of severe fracture and dislocation of lower cervical spine were reviewed from January 2008 to January 2015. Skull traction was installed when the patients were enrolled in the hospital, so the operation was performed as early as possible. Firstly, the posterior procedure was applied to the patients prone on a frame. A standard posterior laminectomy, fixation and fusion were performed with lateral mass screws and rods. The cervical spine reconstruction was achieved by laminecomy, partially facetectomy, leverage and distraction. The technique of rotating rod was applied to recover the sequence of the cervical and keep or increase the zygopophysis and lordosis of the cervical on the sagittal plane. After the skull traction removed, a standard anterior approach to the cervical spine was initiated as the second stage of the procedure. Anterior cervical corpectomy or discectomy, spinal cord decompression, antograft and cervical spine auto-locking plate fixation were carried out. The stability, the fusion rate of the injured segments and spinal cord decompression were observed on the regular postoperative X-ray film and CT scan. The function of the spinal cord was evaluated by American Spinal Injury Association (ASIA) classification.
@*RESULTS@#A total of 137 cases were followed-up, 19 failed to follow-up and 8 of them were due to death. The follow-up time was from 9.0 months to 35.0 months (mean: 13.7 months). All patients got completely reduction of the cervical spine. The injured segments were stable. There was no patient of bone graft no-fusion. The cervical intervertebral height and lordosis were reconstructed and maintained and all grafts were fused at the end of follow-up period. There was no complication related to internal fixation breakage, loosening or displacement. There was also no neurovascular and esophagus complications during the operation. Twelve patients complained neck pain at the final follow-up. There were 12 cases of wound infection and 12 cases of neck inflammatory. They were healed after anti-inflammatory therapy. There were 13 cases of cerebrospinal fluid leakage, and they were healed after the symptomatic treatment. The neuro-function of most patients was improved, and ASIA classification was improved by 1 to 2 grade.
@*CONCLUSION@#Early and one-stage posterior-anterior decompression and reconstruction for the patients with fresh and severe lower cervical spine fracture and dislocation can achieve good reduction and cervical alignment of cervical spine. The injured segments can gain postoperative immediate stability. It also gives a completely decompression, which is benefit to the patients for nursing, functional exercise, and the functional recovery of the spinal cord.

Posterior only approaches versus anterior only approaches and combined posterior and anterior approaches for thorac-ic tuberculosis in adults:minimum 5-year follow-up / 中华骨科杂志

Objective To compare the minimum 5?year follow?up outcomes of surgical management by posterior only ap?proaches, anterior only approaches and combined posterior and anterior approaches for thoracic tuberculosis in adults, and evalu?ate the mid term follow?up results of posterior only approaches. Methods All of 184 patients with monosegment thoracic tubercu?losis between January 2003 and November 2010 were studied retrospectively. Among these patients, 62 cases were treated with posterior debridement combine with interbody fusion (PO group), 65 cases were treated by posterior instrumentation, anterior de?bridement and bone graft in one or two?stage procedures (AP Group ), and 57 cases were treated by anterior only approach (AO Group). The operation time, blood loss, Visual Analogue Scale, complications, recovery of neurological function, kyphosis angle, correction rate and loss angle were respectively compared between each group. Results Comparison of postoperative curative ef?fects showed:mean operation time and blood loss:PO group (260.05±30.75 min,735.95±161.43 ml) was better than AP group (411.65 ± 55.61 min, 1178.65 ± 184.50 ml)and AO group (343.65 ± 24.74 min, 965.35 ± 122.59 ml);corrective angle and correction rate:PO group (6.78°±1.13°, 72.48%±12.97%) and AP group (6.97°±1.05°, 73.10%±11.42%) were better than AO group (13.98°± 1.73°, 44.95%±16.84%);bed time:PO group and AO group were shorter than AP group. Mid term follow?up outcomes showed:ky?phosis angle and loss angle:PO group (8.56°±1.09°, 1.89°±1.41°) and AP group (8.55°±1.65°, 1.63°±1.11°) were better than AO group (16.39°±1.59°, 2.80°±1.29°);bone fusion time, VAS and recovery of neurological function:there were no statistically differ?ence in all groups. Conclusion The mid term follow?up outcomes of posterior debridement combined with interbody fusion is sat?isfied in the management of monosegment thoracic tuberculosis. It is a safe and effective method.

Development of research hospitals headed by medical science innovative / 中华医院管理杂志

The paper introduced the general picture of Xiangya Hospital in the past five years in its development of ahigh-level research hospital of international influence.Aiming at this strategic goal, the hospital proceeds by means of discipline development,talent training,research platform building, international academic exchange,performance appraisal and incentive,budget guarantee and system development.All these efforts contribute to the building of a mutual-supportive,efficient and sustainable medical science innovation system tailored to large hospitals.

Posterior short-segment fusion to treat upper cervical vertebra trauma / 中南大学学报(医学版)

OBJECTIVE@#To investigate the strategies of posterior short-segment fixation and plant iliac fusion surgery, and the clinical efficacy of them on the treatment of upper cervical vertebra trauma.@*METHODS@#Three hundred and thirty-four patients with upper cervical vertebra trauma admitted into our hospital from June, 2005 to April, 2010 were studied retrospectively. Thirty-six were treated by posterior short-segment fusion, which included 22 and 14 male and female patients, respectively. Among them, 23 or 6 patients were related to traffic or falling accident, 5 or 2 patients were related to crashing object or fight. The clinical efficacy was evaluated by head and neck pain VAS score, JOA scores of nerve function and the rate of graft bone fusion.@*RESULTS@#The postoperative VAS scores were lower than that of pre-operation, and the difference was significant (P<0.001). The postoperative JOA scores of nerve function was superior to preoperative scores (P<0.05). During follow-up, no internal fixation failure happened while bony fusion could be seen.@*CONCLUSION@#The method of posterior short-segment fixation and bone graft fusion in treating patients with cervical spine injury is highly efficacy, which possesses great clinical value.

Three-dimensional visualization of angioarchitecture in spinal cord contusion using propagation phase contrast tomography / 中国组织工程研究

BACKGROUND:Propagation phase contrast tomography can greatly improve the spatial resolution of chondrocytes and microvessels depending on the high colimation and high coherence performance of hard X-ray. OBJECTIVE: To detect the alteration of angioarchitecture after spinal cord injury in rats using propagation phase contrast tomography. METHODS: Eight male Sprague-Dawley rats were divided into two groups: in experimental group, an acute spinal cord injury model was induced in rats by the modified Alen’s method; in sham control group, rats were subjected to laminectomy. At 1 day after operation, normal and injured spinal cord segments were taken and treated with formaldehyde-methyl salicylate sequentialy for 48 hours. The segments were scanned by propagation phase contrast tomography in BL13W1 beamline experimental station of Shanghai Synchrotron Radiation Facility, China. Harvested data were analyzed by VGStudio Max 2.1 software for three-dimensional reconstruction and microvasculature quantitative analysis. RESULTS AND CONCLUSION:The propagation phase contrast tomography successfuly simulated the morphology of angioarchitecture folowing spinal cord injury. After acute spinal cord contusion, the destruction of nerve tissues was accompanied by severe microvasculature damage. Intramedulary tissue damage and loss of blood supply was spread from the central zone to the ends. Three-dimensional microvascular quantitative data showed that after spinal cord contusion, the number of microvessels and vascular perfusion volume drasticaly reduced (P < 0.01). These findings indicate that the propagation phase contrast tomography without angiography has potential as a new ultra high-resolution visualization technique for three-dimensional microvessel imaging and quantitative analysis.

The genetic predisposition and the interplay of host genetics and gut microbiome in Crohn disease.

Extensive genetic studies have identified more than 140 loci predisposing to Crohn disease (CD). Several major CD susceptibility genes have been shown to impair biological function with regard to immune response to recognizing and clearance of bacterial infection. Recent human microbiome studies suggest that the gut microbiome composition is differentiated in carriers of many risk variants of major CD susceptibility genes. This interplay between host genetics and its associated gut microbiome may play an essential role in the pathogenesis of CD. The ongoing microbiome research is aimed to investigate the detailed host genetics-microbiome interacting mechanism.

Treatment of multi-segmental cervical spondylosis by long or segmented anterior cervical decompression and fixation surgery / 中南大学学报(医学版)

Objective: To investigate the clinical efficacy of two different anterior cervical surgeries in treatment of multi-segmental cervical spondylosis. Methods: A total of 86 patients with multi-segmental cervical spondylosis were treated by anterior cervical surgery procedure. Among them, 62 and 24 cases were involved in three and four gap, respectively. Each patient underwent the surgery of long or segmented anterior cervical decompression and fixation. Preoperative and postoperative cervical curvature change, internal if xation stability, fusion rate and nerve function were evaluated. Results: All patients were successfully completed the operation, segmented surgery showed better cervical lordosis recovery, but there were no significant difference between long and segmented anterior cervical surgery in blood loss and recovery of neurological function (P>0.05). Conclusion: The segmented anterior cervical surgery has advantages in the treatment of multi-segmental cervical spondylosis.

Histomorphological analyse of accelerating the fibrocartilage layer repair of patella-patellar tendon junction in rabbits by low intensity pulsed ultrasound stimulation / 中南大学学报(医学版)

OBJECTIVE@#To analyse the effect of low intensity pulsed ultrasound stimulation (LIPUS) on accelerating the fibrocartilage layer repair of patella-patellar tendon junction.@*METHODS@#A total of 60 mature female New Zealand white rabbits undergoing standard partial patellectomy were divided into 2 groups randomly. The control group was given comfort treatment and the treatment group was given LIPUS treatment starting from day 3 to the end of week 6 postoperatively. The scheduled time points of animal euthanization would be at week 6, week 12 and week 18 postoperatively. The patella-patellar tendon (PPT) complex would be harvested and cut into sections after decalcification for H&E staining, Safranine o/fast green staining. The thickness and gray value of fibrocartilage layer were analyzed by SANO Microscope Partner image analyzer.@*RESULTS@#At week 6, week 12 and week 18 postoperatively, the fibrocartilage layer in the treatment group was significantly thicker than that in the control group (P<0.01), and the gray value of fibrocartilage layer was significantly smaller than that in the control group (P<0.01).@*CONCLUSION@#LIPUS helps to accelerate the fibrocartilage layer repair of patella-patellar tendon junction in rabbit models.

Effect of tetramethylpyrazine on the expression of macrophage migration inhibitory factor in acute spinal cord injury in rats / 中南大学学报(医学版)

OBJECTIVE@#To determine the effect of tetramethylpyrazine (TMP) on the expression of migration inhibitory factor (MIF) in acute spinal cord injury (ASCI) in rats.@*METHODS@#Allen's weight-drop method was used to establish a rat model of ASCI at T10. A total of 110 adult SD rats were divided into a sham operation group (group S, n=10), a control group (group C, n=50), and a TMP group (group T, n=50). Spinal cord functionality was measured by a modified Rivilin loxotic plate degree, BBB score, and combined behavioral score (CBS) at 1, 3, 5, 7, 14 and 21 d postoperatively. The injured spinal cord tissue samples were harvested at 1, 3, 6, 12 h and 1, 3, 5, 7, 14, 21 d postoperatively (n=5 at each time point) and used to prepare continuous histological sections, in which the expression of MIF was analyzed by immunohistochemistry.@*RESULTS@#The degree in group T measured by modified Rivlin loxotic plate test after the ASCI was significantly higher than that in group C at 7, 14, and 21 d (P<0.05). BBB score in group T was significantly higher than that in group C at 5, 7, 14, and 21 d after the ASCI (P<0.05). CBS score in group C was significantly higher than that in group T at 5, 7, 14, and 21 d after the ASCI (P<0.05). The significantly low number of MIF positive cells was shown in group T when compared with that in group C at 12 h and 1, 3, 5, 7 d after the ASCI (P<0.05). As time passed, there was negative correlation between modified Rivlin loxotic plate degree and MIF expression and also between BBB score and MIF, and there was positive correlation between CBB score and MIF expression.@*CONCLUSION@#TMP has protective effect after the ASCI, and may promote the repair of injured spinal cord tissues. TMP may decrease the MIF expression in cells after the ASCI.

In vivo study on three-dimensional structure of lumbar facet joints based on computerassisted medical image processing method / 医用生物力学

Objective To study three-dimensional feature of the thickness of subchondral cortical bone, the surface area and space width of the facet joints as well as its morphological characteristics and variation, and to compare the differences of these parameters in patients with low back pains and healthy people, based on three dimensional reconstruction images of the facet joints. Methods CT scanning from L1/2 to L5/S1 at supine position was performed on 90 subjects to obtain two-dimensional images of the facet joints and three-dimensional point-cloud data of the subchondral cortical bone, the surface area and space width of the facet joints after reconstruction. Distributions of these parameters between the superior and inferior facet joints and at different regions of the articular process were investigated, and differences of these parameters in lumbar segments, gender, age and symptoms were also compared. Results (1)At superior facet, the largest thickness was located at the cranial region, while at inferior facet, it was located at the caudal region. The thickness of subchondral cortical bone was significantly smaller at central region than at the other regions. A more obvious difference could be observed at the lower lumbar levels（L4/5, L5/S1）. (2)The average surface area of the facet joints was (173.2±3.6) mm2, and it was increased with the lumbar level and age increasing, especially at the L4/5 level and at the age of more than 40. The surface area of superior facet joints was significantly larger than that of inferior facet joints for patients with low back pains (except at L5/S1 level), who had an obviously larger surface area of the facet joints than healthy people. (3)The average thickness of space width of the facet joints was (1.46±0.08) mm, and it was decreased with age decreasing, especially at the age of more than 40. The female had significantly larger space width than the male, while patients with low back pains had significantly smaller space width. At each facet joint, the space at cranial region was significantly larger than that at caudal region, and it was also significantly larger at central region than at surrounding region. These differences were more obvious at the lower three lumbar levels. Conclusions Computer-assistant image processing and reconstruction analysis techniques can accurately measure the relative parameters of lumbar facet joints with complicated structure in three dimensional space. The feature of the facet joints was correlated with shape of the facet joint surface，stress on the joint and degeneration of the joint, so it was a reflection of adaptive changes in human body structure due to the long-term loading on the facet joint.

Application of scar flap tn situ in restorative treatment of keloids on auricula / 中华医学美学美容杂志

ObjectiveTo evaluate the clinical effects of surgery using scar flap in situ combined with radiotherapy in 24 hours in the restorative treatment of keloids on the auricula and the preventive effects of the therapy in the recurrence of the keloids.MethodsThe scar flap in situ was designed,its size was large enough for covering the wound of the keloid on the auricula.The keloids along the designed lines were excised using local anesthesia,the flap was clipped into the one with even thickness and suitable size which covered the wound tensionlessly to ensure that the scar flap in situ survived well,and then the wound was bandaged with pressure and drained when necessary.18-24 hours after the surgery the wound was perpendicularly irradiated by the 5 MeV high energy electron beam (beta particle) of the Siemens Primus linear accelerator.After the dressing change was performed and the drain was removed; the wound was exposed to the irradiation,3-4 Gy segmentation dose per time,and the wound was then bandaged with pressure.The radiation was performed every two days and four times altogether with a total irradiation dose of 12-16 Gy.Stitches were removed 8-10 days after the surgery.ResultsThere were no avascular necrosis in the 25 scar flaps in situ and the wounds were all primary healing with normal color and fine appearance.All the patients were satisfied with the surgery.There was no recurrence of the 23 patients during the 8 to 42 months' follow-up,but there was a tendency to recur in 2 patients after 4-6 months,and the recurrence was controlled after the beta methasone was locally injected for 2-4 times.ConclusionsIt is not necessary to harvest the flaps on the other sites applying the sear flap in situ in the restorative treatment of keloids on the auricula,and therefore it prevents the formation of the keloids on the donor sites.Furthermore,the surgery is simple and the appearance of the auricula is fine,and it presents satisfactory clinical effects to irradiate the wound in 24 hours after the surgery.