Temporal fascial flap: a versatile free flap for coverage of complex skin defects

The use of temporal fascial flap (TFF) as a microsurgical option permits the covering of skin defects which expose bones, nerves and vessels; it also provides a gliding surface which facilitates tendon excursion. Other advantages of the TFF are a reasonably constant surgical anatomy, minimal donor-site morbidity, and a thin and pliable surface which results in good cosmetic contour. In this paper we present our experience using TFF to cover wounds with significant exposed surfaces in different body areas (hands, feet, popliteal fossa); an average of 7 years follow-up is presented. Eleven patients with various wounds are presented: 91% had a successful surgery, and the TFF was able to solve the primary problem. On follow-up it was seen that the surgical aim had been reached, with excellent skin quality in terms of pliability, range of motion and protection from secondary ulceration. All patients were satisfied with the final result, and were able to return to their normal lifestyle. Scars secondary to flap harvesting were of good quality and were able to be hidden by the hair. No significant areas of alopecia were noticed.     

相对静息期的增生性瘢痕和瘢痕疙瘩中Ⅳ型胶原的分布及表达

目的：了解Ⅳ型胶原在相对静息期增生性瘢痕、瘢痕疙瘩中的表达与作用。方法：利用免疫组化的方法检测Ⅳ型胶原在瘢痕中的分布及表达。结果：在所有的病理性瘢痕标本中均有Ⅳ型胶原的表达，在增生性瘢痕中的表达强于而且多于瘢痕疙瘩中的表达。表达区域在瘢痕表皮的基底膜层、血管和皮肤附件的周围。与凋亡相关基因的表达几乎一致。结论：提示我们Ⅳ型胶原与相对静息期增生性瘢痕和瘢痕疙瘩的转归有着重要的关系。     

Pathological study of rabbits' femoral arteries subjected to gunshot wounds combining with seawater immersion

I tisestimatedthattheoccurrenceoffirearminjurytogreatarteriesofthelimbsaverages0.07% 2.4%ofallwarinjuries.1Theoccurrenceissimilarinseaorgroundwarfare.2Inseawarfare,thewoundisoftenimmersedintheseawater.3Ithasnotbeenreportedtoourknowledgeintheliteratureaboutthepathologicalchangesoffirearmwoundsconcomitantseawaterimmersioningreatarteriesanditsinfluence onsurgicalrepair.Inthisstudy,weusedrabbitsas theexperimentalmodelwhosefemoralarterywas subjectedtogunshotwoundandthenimmersedintothe seawatertoobs…     

微小切口皮瓣修剪回植腋臭根治术

目的采用微小切口无疤痕根治腋臭.方法手术切除范围为腋毛分布边缘0.5 cm,局部皮下浸润肿胀麻醉,取腋部皮纹内切口,长约0.5cm,以眼科剪修剪皮下0.3 cm内皮下组织及毛囊、汗腺,皮瓣修成全厚至中厚皮,将其中主要毛囊及汗腺清除,达到根治目的.术后打包加压包扎,6 d拆线.结果全组76例青年患者不需住院,腋毛少有生长,上肢活动完全正常.个别患者术后过多活动和自行松动包扎,使皮下渗血或积液,可自行吸收.结论该手术为腋臭无疤痕根治术,治疗和美容达到完美结合,尤为青年女性所接受.     

增龄对牙周细胞覆盖体外创面的影响

目的:以长期培养的牙周膜和牙龈成纤维细胞模拟老化细胞,在体外创面模型中,就增龄对牙周细胞覆盖创面的影响进行评价。方法:以反复传代12代以上的牙周膜、牙龈成纤维细胞作为老化(实验组)细胞,5代以内的牙周膜、牙龈成纤维细胞作为正常对照组。4种细胞接种于盖玻片直至融合。机械方法刮除部分融合细胞,形成宽约7mm的无细胞条带,即体外创面。创面形成后继续培养2、6、9d,固定玻片并作结晶紫染色。以计算机辅助图像分析系统对细胞覆盖体外创面的面积进行百分比定量,采用SAS6.12软件包进行样本均数的t检验。结果:实验组与对照组比较,实验组的牙周膜、牙龈成纤维细胞覆盖创面面积明显较少,创面形成第6、9d,其覆盖创面面积显著低于对照组,差异有显著性(P<0.05)。实验组与对照组牙周膜、牙龈成纤维细胞覆盖创面面积存在差异,对照组创面形成后第9d牙龈成纤维细胞覆盖创面面积显著高于牙周膜细胞,差异有显著性(P<0.05)。结论:老化牙周膜、牙龈成纤维细胞覆盖创面的能力弱于正常细胞。增龄可能损害牙周细胞对创面的覆盖能力。     

烧伤创面羟脯氨酸含量动态变化的实验研究

为探讨浅Ⅱ度烧伤创面胶原含量的变化及其与创面上皮化的关系，我们对浅Ⅱ度烧伤创面的羟脯氨酸（ＯＨＰ）水平及创面的形态学变化作了动态检测。结果发现烧伤后早期创面表皮缺损，ＯＨＰ含量增高，伤后第３天达峰值，继之随着上皮化的完善，ＯＨＰ水平逐渐下降至正常。我们认为，浅Ⅱ度烧伤创面胶原的含量与上皮化程度有关，良好的上皮化过程有利于控制胶原的过度增生。表皮细胞源因子（ＥＤＦ）可能是表皮细胞调控抑制胶原合成的主要因素。     

皮肤伸展术伸展皮肤的来源及创面闭合的实验研究

为了研究皮肤伸展术伸展皮肤的来源及伸展力作用对创面闭合的影响，采用自制的皮肤应力检测系统，作用于猪胸背部标出的７ｃｍ×３．５ｃｍ创面两侧，在伸展区画水平线与垂直线，以１ｃｍ等距点标记，在模拟创面两侧加力至对合，测等距点的变化范围及大小。并选取后肢对称部位形成７ｃｍ×１０ｃｍ创面，实验组首次清创后即采用伸展力作用于创缘。结果表明，创面两侧５倍～７倍于创面长边的部位，皮肤等距点仍增大，伸长皮肤占创面长边的６１％～８９％；伸展力作用的创面５天后即可缝合，对照组仅缩小２４％～２８％。认为，伸展术可动员周围组织，有利于缩小创面及早期闭合创面。     

外源性bFGF对深Ⅱ度烫伤大鼠创面血管内皮细胞增殖与迁移的影响

目的观察大鼠深Ⅱ度烫伤创面敷用bFGF后肉芽组织中血管增殖与迁移情况,以及相关信号蛋白的表达情况.方法 Wistar大鼠133只随机分为正常对照A组(n=7)、单纯烫伤B组(n=42)、bFGF治疗C组(n=42)、c-fos抗体D组(n=42).利用大鼠30%深Ⅱ度烫伤模型,于伤后3、6小时,1、3、7、 14和21天取创面皮肤标本,运用免疫组织化学染色,检测真皮内血管形成的情况,原位杂交和免疫组织化学技术观察血管内皮细胞增殖细胞核抗原(proliferation cell nuclear antigen,PCNA)、黏着斑蛋白激酶(focal adhesion kinase,FAK)及c-fos的表达情况.免疫荧光手段观察细胞外信号调节激酶(extracellular signal-regulated kinase,ERK)在血管形成中的激活情况.结果 B、C组于伤后7天血管内皮细胞增殖明显,14天后FAK的表达也显著增加.损伤后3～6小时ERK的表达增强,随后1～3天,c-fos亦发生相对应的变化.各时间点D组血管内皮细胞PCNA和FAK的表达均减弱,肉芽组织中微血管的数量低于B组.敷用外源性的bFGF后,血管内皮细胞的增殖与前者变化不显著,但FAK的表达较A组增强明显,ERK的表达也显著增加,特别是c-fos也在伤后1～3天呈增强趋势.结论使用外源性bFGF通过ERK信号通路激活c-fos介导血管内皮细胞的迁移活性;肉芽组织中血管形成能力的增强有助于加速创面愈合进程.     

FGFR1在增生性瘢痕和正常皮肤中的表达

目的　研究FGFR1在增生性瘢痕和正常皮肤中表达的差异。方法　用免疫组织化学、Western -blot、流式细胞仪分析等方法检测FGFR1在增生性瘢痕和正常皮肤组织及相关细胞中的表达差异以及在成纤维细胞中的亚细胞分布状况。结果　FGFR1阳性细胞主要存在于角质形成细胞、汗腺、皮脂腺、血管内皮细胞及成纤维细胞等 ,细胞爬片观察到阳性颗粒主要位于细胞核 ,细胞浆中不如细胞核中明显。FGFR1在单个细胞中的表达量无明显差异。结论　FGFR1在增生性瘢痕和正常皮肤中表达无差异     

Cesarean birth: How to reduce the rate

The cesarean section rate, which approached 25%, has stabilized and started a modest decline. A stated United States national goal by the year 2000 is rate of 15%. Suggested rates are 12% for primary and 3% for repeat cesarean sections. The major indications for cesarean section are prior cesarean delivery (8%), dystocia (7%), breech presentation (4%), fetal distress (2% to 3%), and others. The major areas of reduction must occur in the categories of prior cesarean delivery and dystocia. An expanded use of trial of labor and vaginal birth after a prior cesarean section will produce further reductions. Countries in Europe achieve> 50% vaginal birth after a prior cesarean section compard with 25% in the United States. A heightened awareness must occur regarding the decision to perform the first cesarean section. The residual impact, a scanned uterus, affects 12% to 14% of women seen for delivery. Even if 50% achieve a vaginal birth after a prior cesarean section, the national goals are unachievable. The obstetrician must consciously consider the impact of “once a cesarean, always a scar.”