Objective To explore the technique for reconstructing nasal subunits with the reversed vascularized preauricular and ear composite flap. Methods From June 2003 to August 2005 the preauricular and ear composite flap, which was pedicled by the reversed superficial temporal vessel, was harvested and transplanted to repair the defects of the nasal tip, soft triangle, and ala by the microsurgical technique. The flap ranged in area from 3.5 cm×2.5 cm to 2.0 cm×1.5 cm, with the pedicles 4 to 6 cm in length. The reversed superficial temporal vessel pedicles were directly anastomosed to the angular artery and vein adjacent to the nasal ala. Results Among the 12 patients who had been treated, 11 had their vessel pedicles successfully anastomosed to the angular vessels, while the remaining 1 patient had the stump of the superficial temporal vessel anastomosed after the flap harvest via the vessel graft because the angular vessels were not found in the recipient area. All the flaps survived with a satisfactory esthetic result after operation. Conclusion The technique for reconstructing nasal subunits with the reversed vascularized preauricular and ear composite flap, which is directly anastomosed to the angular vessel, can avoid the vessel grafting and therefore it can avoid an additional damage to the patient.
Objective To observe the anatomic basis and the clinical application of the modified peroneal arterial cutaneous branch nutritional flap. Methods Twenty sides of lower limb of adult colyseptic cadavers and 5 sides of lower limb of adult fresh cadavers were used to detect the cutaneous branches of the peroneal artery. The position where the cutaneous branches come from the peroneal artery and the diameter of the cutaneous branches were recorded. From September 2003 to June 2005, 10 cases of skin and soft tissue defects in the region of metatarsophalangeal point with the modified peroneal arterial cutaneous branch nutritional flap, in which the cutaneous branches from the peroneal artery 11.0±1.7 cm upon the lateral malleolus were added. The defect size was 10 cm×6 cm to 15 cm×10 cm. The flap size was 11.0 cm×6.5 cm to 16.0 cm×11.0 cm. Results There is a stable cutaneous branches from peroneal artery 11.0±1.7 cm upon the lateral malleolus. The diameter of this cutaneous branches at the origin is 1.45±0.12 mm. The distance between the cutaneous branches entrance of the deep fascia and the line of the sural nerve nutritional artery flap was 15.70±1.20 mm. All 10 flaps survived. The blood supply and venous return of the skin flaps were good. The 10 patients were followed up from 6 to 12 months. The shape of the flaps was satisfactory. The texture and the color and luster of the flaps were similar to the adjacent skin. The functions of the feet were good. The twopoint discrimination was 1118 mm. Conclusion The modified peroneal arterial cutaneous branch nutritional flap has good blood supply. It can reverse to a long distance and can repair large skin defects.
Objective To investigate the method and effectiveness of repairing fingertip defects with reverse island flappedicled with terminal dorsal branch of digital artery with sense reconstruction. Methods Between December 2008 and March2010, 32 patients (40 fingers) with fingertip defects were treated. There were 20 males (23 fingers) and 12 females (17 fingers), aged from 20 to 62 years (mean, 42 years). The time between injury and admission was from 1 to 8 hours. The injured fingers included thumb (2 cases), index finger (6 cases), index finger and middle finger (3 cases), middle finger (7 cases), middle finger and ring finger (3 cases),ring finger (8 cases), ring finger and little finger (2 cases), and little finger (1 case). The defect area ranged from 1.2 cm × 1.0 cm to 2.2 cm ×1.8 cm, and the flap area ranged from 1.5 cm × 1.0 cm to 2.5 cm × 2.0 cm. The fingertip defects were repaired by the reverse island flaps pedicled with terminal dorsal branch of digital artery and branch of digital nerve, and the branch of digital nerve was anastomosed withstump of proper digital nerve. The donor sites were repaired with free skin grafts. Results Bl isters occurred in 6 cases (9 fingers) andpartial necrosis of the flaps in 2 cases (2 fingers), which were cured after symptomatic treatment. The other flaps and skin grafts survived and the wounds healed by first intention. Thirty cases (38 fingers) were followed up 6 months postoperatively. The shape, contour of the reconstructed fingertip, and motivation of the fingers were satisfactory. The superficial sensation and deep pain sensation recovered after 6 months of operation. The two-point discrimination was 4-6 mm in 24 fingers, 7-10 mm in 13 fingers, and none in 1 finger. According to the functional assessment criteria of upper l imb formulated by the Hand Surgery Branch of Chinese Medical Association, S3 was achieved in 1 finger, S3+ in 13 fingers, and S4 in 24 fingers. Conclusion It is simple and safe to harvest the reverse island flap pedicled with terminal dorsal branch of digital artery with sense reconstruction; at the same time, the blood supply of the flap is rel iable and its sense can be reconstructed. It is one of effective methods for repairing fingertip defects.
Objective To investigate the basic mechanism of venous flow in reverseflow island flap. Methods Recent relevant literature on the mechanism of venous reverse flow in reverseflow island flap wereextensively reviewed. Results The mechanism of venous reverse flow was a multifactorial phenomenon. “Communicating and collateral by pass route” and “incompetent valve route” were two theories. Conclusion The two routes of venous reverse flow in reverse-flow island flap coexistand complement each other.
Objective：To observe the expression of gene and protein l evel of unfolded protein, glucoseregulated protein 78 (GRP78), after retinal d etachment (RD); to find out the relationship between UPR and the cell damage after RD.
Methods：Eightyeight Wistar rats were divided into 2 groups: con trol group (11 rats) and RD group (77 rats). In RD group, subretinal injection with 10 mg/ml hyaluronic acid sodium was performed on the left eyes of the rats t o set up RD model, and the left eyes and retinal tissue were collected 1/2 day, 1 day, 2, 4, 8, 1 6 and 32 days after RD; there were 11 rats in each subgroup. The expression of G RP78 mRNA in retina tissue was detected by semiquantitative reverse transcript i on polymerase chain reaction (RT－PCR), the expression of GRP78 protein level wa s detected by Western blotting, and the distribution of GRP78 in each retinal lay er was observed by immunofluorescence labeling method and confocal microscopy.
Results：The expression of retinal GRP78 mRNA significantly in creased in 1/2 day , 1 day, 2, and 4 days subgroups after RD (Plt;0.05). The expression of GRP7 8 protein significantly increased in each subgroup after RD compared with which in the control group, and reached the peak in 8, 16, and 32 days subgroups. The expres sion of GRP78 protein was detected in all of the retinal layers after RD.
Conclusion：The protection mechanism of UPR starts up after RD, and l eads the correc t pucker of the protein and reduces cellular injury by upregulating the expres s ion of GRP78, which provide the theoretic basis for reducing the cellular injury and improving the visual function in patients with RD.
Objective To verify whetheriris pigment epithelial cells(IPECs)possess the similar potential of specific phagocytosis to retinal outer segments(ROS) with retinal pigment epithelialcells(RPECs). Methods IPESc were isolated from neonatal bovines with Hu's method,and were cultured.The cultured cells were identified by immunohistochemical methods with antibodies to cytokeratin and s-100.Total RNA of IPECs was extracted by Trizol.The specific primers for mannose-receptor andbeta;-actin were designed according to their sequence from Genbank.The mRNA expression of these proteins in the IPECs was analyzed by reverse transcription polymerase chain-reaction (RT-PCT).Results The Cultured IPECs have no contamination of other cells .The extracted RNA was ideal and had no degradation.RT-PCR analysis showed that mannose-receptor's mRNA was expressed in cultured IPECs in vitro.ConclusionCultured IPECs may express the mannose-receptor,and may have similar potential of phagocytosis to ROS with REPCs.
Objective
To investigate the effect of hypoxia on expressions of erythropoietin（EPO）mRNA and protein in retinal Muuml;ller cells cultured in vitro.
Methods
Retina tissues from the new-born Wistar rats were dissected into cell suspension after digested by pancreatin.Muuml;ller cells were separated and purified by mechanical concussion and blowing and striking method.The expression of EPO mRNA and protein under the condition of hypoxia was detected by semi-quantitative reverse transcriptase（RT）-polymerase chain reaction（PCR）and immunocytochemical method.
Results
Retinal Muuml;ller cells were cultured successfully，95% of which were positively stained by glial fibrillary acidic protein（GFAP）.Positively stained EPO protein was located in the cytoplasm and protuberance.The expression of EPO mRNA and protein was faint in the normal retinal Muuml;ller cells，but increased obviously and time-dependently after hypoxia.
Conclusion
Expression of EPO mRNA and protein increases in Muuml;ller cells after hypoxia，which may be one of the protective factors for the nerves in anoxic retinopathy.
(Chin J Ocul Fundus Dis, 2006, 22: 196-199)
Objective To observe the survival rate of reversed-flow free flap after anastomosing one venous reverse flow and to explore the change of intravenous pressure and mechanism of venous reverse flow. Methods Thefree vascularized posterior tibial flap with reversed flow was successfully established in NewZealand white rabbits.Fifteen rabbits were randomly allocated into 3 groups of 30 flaps. In group A,two vena comitans were anastomosed.In groups B and C,only onevenae comitans was anastomosed. In groups A and B,intravenous pressure was measured immediately and 30,60 and 120 minutes after anastomosing the vascular pedicle.Flap survival rate of group B was measured after two weeks. In group C, radiography of one venae comitans was observed.The diameters of posterior tibial vessels was measured on all the rabbits before anastomosing the vascular pedicle. Results The diameters of posterior tibial artery was 8.0±0.3mm and of vena comitans was 11.0±0.5 mm。The intravenous pressure of group B increased rapidly and reached its top value after about 30 minutes (P＜0.05).It then decreased and approached normal level after about 60 minutes (Pgt;0.05).The intravenous pressure was not significantly different between groups A and B in each time interval (Pgt;0.05).Two flapsresulted in avulsion,infection and necrosis.The remaining 8 flaps survived completely.Most of the radiopaque in group C flew back to the proximal tibia one hourlater. Conclusion Venous retrograde return is abundant in reverseflow free flap of anatomosing one vena comitans.The main way of venous reflux in reverseflow free flap can be through “direct incompetent valve route”.
Objective To research the effects of vascular endothelial growth factor (VEGF) on the survival of reverse flow axial skin flaps. Methods A 8 cm×2 cm full thickness transverse dorsal flap based on right deep circumflex iliacartery was elevated in 20 SpragueDawley rats, which length crossing midline was 4.0 cm. The rats were randomized into two groups:experimental group (n=10), subcutaneous VEGF injections into the flap (200 ng, 200 μl) after flap elevation; controlgroup (n=10), subcutaneous saline injections into the flap (200 μl) after flap elevation. The flap was immediately sutured to its recipient beds then the injection was executed. Seven days after operation, the survival area of flaps and density of vessels were observed and measured, meanwhile its histological representation of the flaps was examined. Results After 7 days of recovery, the mean survival area of flaps was 15.55±0.27 cm2 in experimental group and 13.42±0.57 cm2 in control group. The difference was significant between experimental group and control group (P＜0.01). The mean vessel density of flaps was 21.00±3.16 in control group and 34.40±3.75 in experimental group. The difference was significant between experimental group and control group (P＜0.01). Histological analysis demonstrated that a qualitatively greater amount of granulation tissue, regular collagen fiber and a lot of fibrillated cells were observed in experimental group. Erythrocytes were leaked outfrom vessels, and inflammatory cells were observed around in control group. Conclusion In early survival of flaps, the VEGF can improve the survival of areverse flow axial skin flap through improving angiogenesis and increasing the perfusion of vessel. It is an effective method of improving the survival of reverse flow axial skin flaps that VEGF is fully injected in subcutaneous flaps by single, when flaps are elevated.
Objective To investigate the clinical effect of the reverse transposition of pedicled soleus muscle flap in repairing soft tissue defects after Pilon fracture fixation. Methods From May 2002 to June 2006, 14 patients (11 males, 3 females; aging 2050 years) with soft tissue defects afterPilon fracture fixationunderwent repairing operations with the reverse soleus muscle flaps. The soft tissue defects ranged from 7.0 cm×3.5 cm to 100 cm×60 cm. Of the patients, Pilon fractures were treated by internal fixations in 9 cases, open Pilon fractures weretreated by external fixations in 5 cases. The area of muscle flap ranged from 8.5 cm×5.5 cm to 12.5 cm×7.5 cm. Results All patients achieved primary healings, and the grafting skin survived. Twelve flaps survived completely but 2 flapshad mildinfection, which survived after dressing change. Eleven patients were followed up for 3 to 26 months, averaged 15 months. The flap appearances were good and smooth without ulceration. The dorsiflexion ranges of ankle joint were 10-25°, and plantar flexion ranges were 15-40°. The gait was normal. Conclusion The reverse soleus muscle flap is no need to reveal blood vessel pedicle and has constant position of anatomy. It has big muscle belly, convenient to move and circuitation 180°. It is profitable to reduce infection rate and to promote wound healing to raise local osteotylus.
