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This article briefly introduces the development history of Department of Burns and Cutaneous Surgery in Xijing Hospital of Air Force Medical University (the former the Fourth Military Medical University) since its establishment more than 60 years ago. The medical staff of the department have been adhering to the treatment concept of the older generation of experts and professors, applying the principles and methods of plastic surgery to the treatment of deep burn wounds. Furthermore, the new techniques in the field of flap surgery, microsurgery, and minimally invasive surgery are applied to repair various complex wounds after burn/trauma and severe scar deformities. Our department has formed our own distinctive technical features and contributed to the development of burn cause in China.

Objective: To evaluate the clinical effect of acellular dermal matrix (ADM) on the repair of different tissue defects in pharyngeal and laryngeal cancer., Method: Twenty-three cases of pharyngeal and laryngeal cancer were analyzed retrospectively, including 16 patients with pharyngeal cancer, and 7 patients with laryngeal cancer. After surgery, the patients appeared two types of tissue defects respectively: hypopharynx tissue defect and neck skin tissue defect. These defects were repaired with ADM, and the clinical effects were observed., Result: Sixteen cases of hypopharynx tissue defect and 7 cases of neck skin tissue defect were repaired with ADM. One case in hypopharynx tissue defect group and 2 cases in neck skin tissue defect group undergone pharyngeal fistula postoperatively., Conclusion: The repair of tissue defects in pharyngeal and laryngeal cancer with ADM had some advantages, such as good histocompatibility, low immune rejection, wide material sources and simple method. There were some differences in clinical effects between hypopharynx cavity defect and neck skin tissue defects, so the emphasis of the need to pay attention to is different in the clinical.

Objective: To explore the clinical repair value of facial skin and tissue defect caused by tumour, trauma and infection with the axial flap., Method: The clinical data of 38 patients with facial skin and tissue defect were analyzed retrospectively. All of them were repaired by the axial flap., Result: The axial flap was alive in all patients, and all incision healed in the first stage. All patients had a satisfied result after the second stage of flap surgery., Conclusion: The method of the axial flap in face can be clinically applied in the facial skin and tissue defects caused by tumour, trauma injury and infection. Because the axial flap cotained named blood vessel, the survival rate of it is high.

Objective: To compare the effect on surgical indicators and functional outcome between preoperative skeletal traction and skin traction for adult femoral fracture and guide the choice of preoperative traction method of adult femoral fractures., Methods: From February 2008 to September 2012, 68 patients aged greater than 18-year-old with femoral fractures were treated and randomly divided into two groups according hospitalization order,the odd with skeletal traction of tibial tubercle (group A) and the even with skin traction (group B). In group A, there were 25 males and 9 females with an average age of (36.3±9.9) years old,including 11 cases with transverse fracture, 15 cases with oblique fracture, 8 cases with spiral fracture. In group B, there 26 males and 8 females with an average age of (37.1±11.0) years old,including 10 cases with transverse fracture, 13 cases with oblique fracture,11 cases with spiral fracture. The operative time,blood loss,the number and amount of blood transfusion ,fracture healing time, hemoglobin, pain scores and functional scores between two groups were analyzed and compared. Results:All patients were followed up, the follow-up time was (33.5±6.5) months in group A, (31.3±7.5) months in groupB. In group A,the operation time was (108.8±14.2) min and the intraoperative blood loss was (383.1±117.1) ml and the postoperative blood transfusion was 14 cases and the blood transfusion was (350.0±122.5) ml and the average bone healing time was(15.0±3.3) weeks. In group B, the operation time was (111.6±12.7) min and the intraoperative blood loss was (392.0± 116.7) ml and the blood transfusion was 11 cases and the blood transfusion was(327.3±129.1) ml and the average healing time was (15.5±3.4) weeks. These obseration indicators had no significant difference between two groups. There was no significant difference between two groups in terms of Hemoglobin, the pain scores before and after traction, the femoral fractures efficacy score,knee function score and knee range., Conclusion: Preoperative skeletal traction does not reduce surgery time, blood loss and pain and so on. The bone healing time and limb functional outcomes were also not significantly improved.

Objective: To investigate the change law of the intracapsular pressure in vitro without outside force and the pressure of the expander upon the skin soft tissue in vivo during clinical routine expansion so as to provide some references for the safe application of the expander., Methods: The rectangle expanders of 50, 80, 100, 150, 200, 250, 300, and 400 mL were used for in vitro expansion at room temperature to 400% volume of the expander capacity. The pressures before and after saline injection were recorded. Twelve patients who needed scar plastic surgery were enrolled; 17 rectangle expanders were implanted in 5 areas (cheek, trunk, forehead and temporal, limb, and head) and expanded routinely. The pressures before and after saline injection were recorded. The pressure of the expander upon the skin soft tissue was calculated and the values of the pressure at 50%, 100%, 150%, and 200% volume of 5 areas were chosen and analyzed statistically., Results: The intracapsular pressure of the expanders at different volumes in vitro without outside force during routine expansion before and after saline injection was beyond 0 mm Hg (1 mm Hg=0.133 kPa) at around 100% volume, increased rapidly from 100% to 250% volume, and kept stable from 250% to 400% volume. In vivo, 16 expanders within 200% volume had the maximum pressure before saline injection, 15 had the maximum pressure after saline injection. Before saline injection, the pressure of the expander upon the skin soft tissue was lowest in the cheek, showing significant difference when compared with those of the forehead and temporal and head (P < 0.05); the pressure in the trunk was significantly lower than that in the head (P < 0.05); and there was no significant difference between the other body sites (P > 0.05). After saline injection, the pressure of the expander upon the skin soft tissue was lowest in the cheek, and showed an increasing trend in the trunk, the limb, the forehead and temporal, and the head; no significant difference was found between in the cheek and in the trunk, and between in the forehead and temporal and in the limb (P > 0.05), and significant differences were found between the other body sites (P < 0.05)., Conclusion: The pressure of expander upon skin soft tissue at early stage or middle stage is higher than that at late stage during expansion. The pressure is high in the head, and low in the cheek comparatively, and the pressures in the trunk, the forehead and temporal, and the limb are between them.

Objective: To introduce a modified method to correct type I and type II cup ear and to evaluate the effectiveness., Methods: Between May 2006 and November 2011, 23 patients with type I or type II cup ear (27 ears, type I in 6 ears and type II in 21 ears according to Tanzer's criteria) were treated. There were 14 males and 9 females with an average age of 10 years (range, 7-16 years). The unilateral ear was involved in 19 cases and bilateral ears in 4 cases. The main clinical manifestations included the flat helix and scapha and ptosis of upper 1/3 auricle. The arc incision was adopted in the auriculocephalic angle, elevation of the dis-clothing-like flap in the front and rear of the auricular cartilage, relocation of the craniofacial initiation site of the scapha and the cavity of auricular concha, correction of deformational auricular cartilage and reconstruction of smooth helix, antihelix, superior and inferior antihelix crus., Results: All the incisions healed by first intention without any hematoma, postoperative infection, or flap necrosis. All patients were followed up 9 months-6 years (median, 36 months). No auricle ptosis, deformity contour, or atrophy was observed. The structure of the helix, scapha, and antihelix were clear, natural, and excellent. The scars at the local site were limited and unconspicuous., Conclusion: Modified method can almost correct all the anatomic defects of cup ear. It is an ideal method to treat type I and type II cup ear.

Objective: To observe the effectiveness of skin graft combined with thorax wire fastening for repairing postoperative coloboma after resection of chest back giant nevus., Methods: Between June 2007 and October 2010, 17 cases of chest back giant nevus were treated. There were 7 males and 10 females, aged from 3 years and 6 months to 15 years (mean, 8 years). The size of giant nevus was 20 cm x 12 cm to 60 cm x 50 cm. Two cases of them were ever treated by laser, while the others were never treated. The check before operation showed ulcer of the skin and effusion in 2 cases, hard skin in 3 cases, hair growth in 7 cases, and normal in 5 cases. Five cases had serious itch. After giant nevus was cut off, thorax wire was fastened to reduce the wound area, and then the intermediate split thickness skin graft of thigh was used to repair the wound. Comprehensive anti-scar treatment was given postoperatively., Results: The wound size was (2 110.74 +/- 725.69) cm2 after resection of giant nevus, and was (1 624.94 +/- 560.57) cm2 after thorax wire fastening, showing significant difference (t = 9.006, P = 0.001). All the grafting skin survived; the incision and wound at donor site healed by first intention. The patients were followed up 6 months to 2 years (mean, 13 months). No scar proliferation or contracture occurred. The skin color and elasticity were similar to the normal skin; the nipple, navel, and other local apparatus were not shifted after operation., Conclusion: It can reduce donor site of skin and postoperative scar, and achieve satisfactory appearance to cover the wound by skin graft combined with thorax wire fastening after chest back giant nevus was cut off.

Objective: To evaluate the effects of mixed grafting of allogeneic PADM and autologous STS on wound healing of full-thickness defect in rats., Methods: Full-thickness defects with size of 6 cm x 4 cm were produced on the back of 12 SD rats, and they were divided into E group (n = 6) and C group (n = 6) according to the random number table. The wounds in E group were grafted with a mix of allogeneic PADM (expansion rate 10: 5) and autologous STS with thickness of 0.2 mm, while those in C group were grafted with autologous STS in the same thickness. The wound healing rate, survival rate, contraction rate, and expansion rate of transplanted skin were observed at post operation week (POW) 2, 3, 4, 6, 8, 12, 20. Tissue samples form wounds and surrounding normal skin were harvested at POW 20 for histopathological observation as follows. The structure of collagen fiber bundle was observed by HE staining, the diameter and gap rate of collagen fiber bundle were also measured. The distribution of type I and III collagen was observed by sircus red staining, and the contents of type I, III collagen and their ratio were also examined. Data were processed with independent samples t test, Levene test, and t' test., Results: Survival rate of transplanted skin in E group at POW 2 [(76.1 +/- 13.1)%] was obviously lower than that in C group [(94.5 +/- 1.3)%, t' = 3.440, P = 0.018]. Contraction rate of transplanted skin in E, C groups at POW 3 showed significant difference [(34 +/- 8)% vs. (16 +/- 12)%, t = -3.211, P = 0.009]. Compared with those in peri-wound normal skin, collagen fiber bundles in C group showed signs of homogenization, and collagen fibers were thin with irregular arrangement. Collagen fiber structure and arrangement of composite skin in E group were similar to those surrounding normal skin with incomplete degradation of PADM. Diameter of collagen fiber bundle [(9.6 +/- 0.8) microm], gap rate between collagen bundle [(24 +/- 5)%], content of type I collagen [(80.2 +/- 5.4)%] and the ratio of type I to type III collagen (4.3 +/- 1.2) in E group were all increased as compared with those in C group [(7.3 +/- 1.4) microm (t = -3.562, P = 0.005), (17 +/- 4)% (t = -2.760, P = 0.020), (68.1 +/- 8.4)% (t = -2.981, P = 0.014), 2.3 +/- 1.0 (t = -3.204, P = 0.009)], while content of type III collagen [(19.8 +/- 5.4)%] in E group was lower than that in C group [(32.0 +/- 8.4)%, t = 2. 981, P = 0.014]. Above-mentioned indexes of collagen in wound of E group were similar to those of normal skin surrounding the wound., Conclusions: Allogeneic PADM used as dermal regeneration template is beneficial in improving collagen fiber bundle structure in dermis layer of rats with full-thickness skin wounds when repaired with autologous STS, and it accelerates maturation of regenerative dermal tissue.

Bariatric surgery, an important treatment modality for pathological obesity, has been increasingly accepted by obese patients. However, the excess skin and the relaxation of muscles and soft tissues after bariatric surgery also bring many troubles and severely affect the quality of life. Body contouring after weight loss surgery can increase the patients satisfaction and self-confidence.

Objective: To explore an effective method for repairing the large skin and vessel defect of upper arm., Methods: The large skin defect was repaired by the free anterolateral thigh flap. The vessel defect was reconstructed with the end branch of descending branch from lateral femoral circumflex artery, or the large muscular branch through bridge-like vascular anastomosis., Results: Since 2003, 5 cases were treated. All the flaps survived completely with a soft tissue texture. They were followed up for 8-24 months. The cosmetic and functional results were both satisfactory with less morbidity in the donor sites. The blood supply of the flap and the end of extremities was not affected by weather., Conclusions: Anterolateral thigh flap is very suitable for large skin and vessel defect of upper arm.

Objective: To explore an anatomical basis and incising scope for the medial plantar artery combined flaps and its feasibility of repairing heel and adjacent vast soft tissue defects., Methods: The origin, branches, course and distribution of the medial plantar artery were studied in 20 legs of adult cadavers. The largest area of healthy adult's medial plantar and medialis pedis scope that could be incised for the combined flap was measured. Ten cases of heel and adjacent vast soft tissue defects were repaired by the combined medial plantar and medialis pedis flaps. Age range 28-60 years old. The areas of flaps were 9 cm x 7 cm - 10 cm x 8 cm. Defects of tendo calcaneus were repaired by the tendon of abductor muscle and plantar fascia in 3 cases with skin grafts on the donor sites., Results: The medial plantar artery gave off deep branch (diameter: 1.5 mm +/- 0.3 mm) and superficial branch (diameter: 1.0 mm +/- 0.2 mm). The length of media plantar artery deep branch was (8.9 +/- 0.2) cm and gave off 3-5 cutaneous branches. The largest area of combined flap was about 10.4 cm x 9.2 cm - 9.1 cm x 8.2 cm. Ten flaps survived completely. Eight flaps were followed up for 1 month to 1.5 years. The color, texture and appearance of flaps were excellent. The flaps of two-point discrimination were not different with opposite medial region. The affected limb exercised freely and had no ulceration on the flap., Conclusions: The combined flap has a reliable blood supply and it can recover good sensation after operation. It is one of ideal flaps to repair heel and adjacent vast soft tissue defects. Its disadvantage is a complicated operation.

Objective: To study the effect of tissue-engineered skin loaded with keratinocyte growth factor (KGF) nanocapsules for skin defect on athymic mice., Methods: The acellular dermal matrix (ADM) loaded with KGF-ADM was constructed by means of phacoemulsification solvent evaporation and low temperature drying. The human epidermal stem cells and fibroblasts were captured and identified, then cultivated on the surface of the KGF-ADM. The cell growth was observed. The tissue-engineered skin without KGF was used as sham group. The autogenous skin graft was used as control group. 2 and 6 weeks after the skin was transplanted to the back of athymic mice, the contraction and histological healing of the transplanted skins were observed respectively. Then the immunofluorescence examination with anti-human K10-FITC and beta1-integrin-Cy3 were applied to detect the origin, growth and differentiation of epidermal and dermal cells in tissue-engineered skin., Results: The epidermal stem cells grew well and attached tightly on KGF-ADM. There were small round stem cells and polygonal terminally-differentiated cells, which appeared a partly cloning growth and a tendency of merging. The tissue-engineered skin with KGF nanocapsules gained better result in repairing the skin defects as compared with the blank group and the control group 2 and 6 weeks after transplantation. The regenerative skin cells could connect and mix closely with the athymic mouse skin cells on the border of skin defect. Meanwhile, the regenerative skin existed some contraction. The histological observation with HE staining showed that the regenerative skin possessed intact epidermis with several cell layers and normal keratose stratum, among which there were still some beta1-integrin (+) cells which represented epidermal stem cells or transient amplifying cells when they were tested by immunofluorescence after 6 weeks of transplantation., Conclusions: The tissue-engineered skin loaded with KGF nanocapsules had a better result in repairing athymic mice skin defects than common tissue-engineered skin without KGF nanocapsules or skin auto-graft.

Objective: To evaluate therapeutic effects of traditional Chinese drug soaking,continual irrigation and focus elimination for foot osteomyelitis complicated with massive skin defect and denervation., Methods: There were 25 males and 28 females in the study. All the patients suffering from foot osteomyelitis complicated with massive skin defect and denervation were treated with comprehensive therapy including preoperative traditional Chinese drug soaking, skin release, focus elimination,continual irrigation, and two-stage suture if necessary. Among the patients, there were 42 cases of left foot and 11 cases of right one. Fifty-one patients complicated with skin defect and sinus tract,only 2 patients complicated with skin defect. There were 48 patients with denervation caused by spina bifida, 5 patients by other causes., Results: The follow-up duration was from 1 to 12 years,the mean time was about 5 years. Osteomyelitis recurred in 3 cases and skin defect reoccurred in original position in 9 cases., Conclusion: The methods of traditional Chinese drug soaking, continual irrigation and elimination of focus have good effects for foot osteomyelitis complicated with massive skin defect and denervation. To some degree,this therapy may avoid skin flap transplantation, bone graft and amputation. It deserves further studies and promotion.

Objective: To investigate the repair of skin and soft tissue defect by skin and soft tissue distraction tecnique and evaluate clinical results., Methods: Twenty-five patients with skin and soft tissue defect were repaired by skin and soft tissue distraction technique including 16 male and 9 female. The age ranged from 8 to 66 years with an average age of 29.3 years. Parallel Kirschner wires were inserted through the defect skin margin at the interval of every 0.5 to 1.5 cm, the Kirschner wire was gradually drawed to the close by thick silk thread or tiny steel-wire, the defect of skin and soft tiuuse was closed from two sides and the wound disappeared., Results: The wounds of 15 patients were anastomosed dircetly through skin and soft tissue distraction for 20 to 60 minutes, other ten wounds were anastomosed from 3 to 26 days, all healed well. By the follow up from 2 to 26 months, the wound skin looked as line scar, corresponding to the result of common debridement anastomosis., Conclusion: Skin and soft tissue distraction tecnique can not replace skin grafting, flap transferring and flap grafting. But it may avoid damage to the supply area and the risk of flap necrosis. Skin and soft tissue distraction tecnique is a good method to repair skin and soft tissue defect.

Objective: To search for a feasibility of repairing full-thickness cutaneous deficiency with tissue engineered skin substitute composited by human epidermal stem cells and fibroblasts in fibrin frame., Methods: Epidermal stem cells and fibroblasts were harvested from human epidermis and dermis by trypsin digestion. Cells were cultured and subcultured in non-serum medium. Epidermal stem cells (5 x 10(4)/mL) and dermal fibroblasts (1 x 10(4)/mL) in 0.5 mL medium were coagulated in 0.5 mL fibrin frame to construct tissue engineered skin substitute. The tissue engineered skin substitute was grafted onto full-thickness cutaneous deficiency of nude mice. Forty-five male mice, 4-5 week old, weighted 20 g on average, were randomly divided into 5 groups. Oil yarn (group C), fibrin frame membrane without cell inoculation (group F), composite skin substitute with epidermal stem cells (group S) and composite skin substitute with fibroblasts (group Fb) were used as controls, while tissue engineered skin substitute (group T) was experimental group. The wounds were observed 1, 3, 6, 8 weeks after surgery. Samples were harvested 3, 6, 8 weeks after surgery, and were examined by means of histology, immunohistochemistry and scanning electron microscopy (SEM)., Results: Four weeks after cell culture, there were some round cells in the culture capsule of epidemic cells, and some fusiform cells in the culture capsule of fibroblast. Six days after cells were cultured in the BrdU culture medium, there were some BrdU positive cells appeared. There were some CK19 positive cells and Nestin positive cells appeared in the chaff of group T before transplanting. The new formed skin of group T grew faster and had less scar than other groups. Six weeks after surgery, the average thickness of new formed skin was (0.460 +/- 0.049) mm in group C, (0.480 +/- 0.055) mm in group F, (0.540 +/- 0.043) mm in group S, (0.5 10 +/- 0.032) mm in group Fb, (0.660 +/- 0.047) mm in group T. The thickness of new formed skin in group T was thicker than other groups (P < 0.05). By histology and SEM observation, 3, 6, 8 weeks after surgery, the new formed cuticular layer, fibroblast and blood vessels in the group T were more than those in the other groups. The alignment of blood vessels and collagen fibers in group T were much regular than those in the other groups. Three weeks after surgery, the new formed skin of group T had a continuous color zone of positive collagen IV staining, while no continuous color zone was found in the other groups. Six weeks after surgery, CK14 positive cells appeared in the new formed skin of group T, while no positive cell was found in the other groups., Conclusion: Tissue engineered skin substitute which is composited with epidermal stem cells and fibroblasts in fibrin frame has potential prospects in application of repairing full-thickness cutaneous deficiency with advantage of faster wound healing.

Objective: To explore the possibility of creating a rat new scar model by inserting gelatin sponge into rat excisional wounds., Methods: Two full-thickness wounds were created in each of total 49 SD rats. In the Experimental group (n = 19), a regular incisional wound (1 cm) was created on the left side, and an excisional wound of 1.0 cm x 0.2 cm was created on the right side with a gelatin sponge inserted. In control 1 group (n = 15), an excisional wound with sponge insertion was created on both sides of rats. In control 2 group (n = 15), two excisional wounds were created on both sides, and only one side wounds were inserted with a sponge. Animals were sacrificed at various time points for different examinations., Results: The wound/scar width increased 4 - 11 times in inserted wounds than in regular incisional wounds (P < 0.01), with an obvious delay of epithelialization. No difference in wound/scar width was found in both sides of wounds of control 1 group at various locations. In contrast to the linear scar of sponge-inserted wounds, contracted and irregular scar was found in non-inserted wounds of control 2 group., Conclusions: Gelatin sponge insertion can create a thick linear scar in rat wounds, and thus provides a new model for scar research.

Objective: To investigate the application of acellular dermal mesh in female pelvic reconstruction surgery., Methods: Twenty patients underwent the operation for pelvic organ prolapse, who were admitted from May 2006 to December 2006 into Peking University People's Hospital. Acellular dermal mesh was used for pelvic floor reconstruction in the operation. The average age was 66 (43-77) years. The number of patients with the uterine prolapse was 19, and the other one patient was vaginal vault prolapse. Twenty cases had the anterior vaginal wall prolapse, and 17 cases were with the posterior vaginal wall prolapse. Fifteen cases received anterior vaginal wall reparation with acellular dermal mesh, and 2 cases received the posterior vaginal wall reparation with acellular dermal mesh. Both of the anterior and posterior vaginal walls were repaired with acellular dermal mesh in 3 cases., Results: The mean operation time was 113.1 minutes (70-180 minutes). The mean time of mesh placement was about 10 min only. The mean hemorrhage was 175 ml (50-300 ml). All the patients recovered well after operation. The mean period of follow-up after operation was 9. 3 months (6-12 months). No erosion or infection was found. Four cases of recurrence (20% )were found. Three cases of them were of stage I recurrence with no symptoms. One case of them was of stage II recurrence with no symptoms. And the recurrences were found at a half year after operation., Conclusions: The application of acellular dermal mesh in female pelvic reconstruction surgery is easy and simple. Patient tolerance is good. However, the long term effect is still uncertain.

Objective: To investigate the effects of glutathione (GSH) on survival of the random skin flap in rats and the probable mechanism that contribute to this effect., Methods: Twenty SD rats with 200-250 g in weight, were randomly divided into the experimental group and control group(n = 10). Random flap of 8 cm x 2 cm in size was made on the back of each rat with the pedicel on the angular of the scapular. GSH (250 mg/kg) and NS of the same dose were injected into the abdominal cavity of rats in the experimental group and the control group immediately after the operative, 1st and 2nd days respectively. The rats were killed on the 7th day after the operation. The tissue pathology, the survival rate of the flap, the superoxide dismutase (SOD) activity and malonyldialdehyde (MDA) level were compared between two groups., Results: The mean survival rate of the flap on the 7th day in the experimental group (56.77% +/- 10.67%) was higher than that in the control group (40.16% +/- 7.12%) (P < 0.05). SOD activity in experimental group (306.06 +/- 84.87 U/mgprot) was higher than that in the control group (224.79 +/- 27.12 U/mgprot), while MDA level (3.835 +/- 0.457 nmol/mgprot) was lower than that in the control group (6. 127+0. 837 nmol/mgprot) (P < 0.05). Histological observation showed that the neutrophil infiltration was less in experimental group than that in the control group; that the experimental group was surperior to the control group in angiogenesis, fibroblasts, fair cells and cuaneous gland., Conclusion: The intraperitoneal use of GSH may promote the survival rate of the random flaps and the possible mechanism for improvement may lies in that the GSH can reduce the level of oxygen free radical and lipidperoxidation, and lessen neutrophil infiltration.

Objective: To investigate the method and clinical effect of free iliac flap grafting in repairing the tibia traumatic osteomyelitis complicated with bone-skin defect., Methods: From June 2001 to February 2006, 28 patients with tibia traumatic osteomyelitis complicated with bone-skin defect were treated with free iliac flap grafting at stage I. There were 18 males and 10 females, with an average of 32.5 years(18-68 years). There were traffic injury in 11 cases, bruise in 6 cases, explosive injury in 5 cases, machinery injury in 4 cases, and falling injury in 2 cases. The disease courses of patients were 1-6 months. All patients had been treated by 2-6 operations. The wounds located at the mid and upper tibia in 13 cases, and the inferior tibia in 15 cases. The length of free iliac was 0.5-6.0 cm and the size of the flap ranged from 4.5 cm x 3.5 cm to 28.0 cm x 16.0 cm. The external fixation were applied in 18 cases, and steel plate were applied in 10 cases. The donor sites were sutured directly., Results: All of the flaps survived completely. The wounds healed by first intention in 26 cases and by second intention in 2 cases. The donor sites healed by first intention. Twenty-eight patients were followed up for 6 to 56 months (mean, 30 months). The appearances of the flaps were satisfactory and the colour was similar to recipient site. All grafted bone united 2-14 months (mean, 4.6 months) after operation according to X-ray examination. In 20 patients who did not achieved union before operation, fracture healed 2 to 6 months after operation(mean, 3.2 months). Osteomyelitis recurred 12 months after operation in 2 cases and healed by nidus clearing., Conclusion: Free iliac flap which used to repair tibia traumatic osteomyelitis complicated with bone-skin defect, can repair the defect at stage I and enhance the anti-infectious ability. It is one of appropriate and effective clinical methods.

Objective: To classify the blood vessel distribution of the expanded skin in the mastoid region and its relevance to reasonable and reliable design of the expanded flap for auricular reconstruction in congenital microtia., Methods: The blood vessel distribution of the expanded skin in the mastoid region was observed by light permeation test. The expanded flaps with different ratio of length to width were designed according to their blood vessel distribution types., Results: The vascular distribution of the expanded skin in 403 cases was divided into five types. All the flaps survived completely., Conclusions: The blood vessel distribution type of the expanded skin in mastoid region has great significance for the design of post-auricular expanded flap in auricular reconstruction.

Objective: To investigate the feasibility of using the porcine small intestinal submucosa (SIS) as a kind of the new tissue engineered materials to repair the rat full skin defect., Methods: Twenty-eight 6-week-old SD rats weighing 300-350 g were selected in this experimental study. Two 2-cm-diameter round full skin defects were made on the rat back. The upper round defect was used as the blank group, which had no coverings, and the lower round defect was used as the SIS group. SIS that had been produced earlier was transplanted in the defected area. At 3 days, 1, 2, 3, 4, 6 and 8 weeks after the transplantation, the observation was made on the repaired skin conditions, the HE stain, and the repaired skin proportion., Results: There was no infection in the two groups. The repairing speed in the SIS group was faster than that in the blank group at 2, 3, 4 and 6 weeks after the transplantation. The skin repaired by SIS was soft and elastic in texture, which had the same high level as the normal skin. The scar tissues in the SIS group were thinner than those in the blank group. The repaired skin proportions at 1, 2, 3, 4, 6 and 8 weeks after the transplantation were 15.72%+/-3.64%, 43.81%+/-4.87%, 65.35%+/-5.63%, 87.95%+/-4.78%, 96.90%+/-6.89% and 100%, respectively in the SIS group, and 13.42%+/-5.63%, 58.74%+/-4.48%, 76.50%+/-5.23%, 92.30%+/-5.75% and 100%, respectively in the blank group. There was a statistically significant difference between the two groups at 1, 2, 3 and 4 weeks after the transplantation (P<0.05). Under the microscope, the SIS-repaired skin was observed to have more keratinocytes and collagen tissues, which was familiar to the normal skin., Conclusion: Porcine SIS can be used as a new kind of the tissue engineered materials to repair the full skin defect.

To measure and analyze the spectrum of a small skin region for laser therapy of port wine stain is very useful for clinical doctor to understand the optical characters of patient's pigmented skin, to adjust the output parameters of lasers and then to improve the therapy effects. Based on the analysis of the forming mechanism of port wine stains and clinical operation of the disease, the present paper presents an automatic spectral measurement and analysis system for port wine stain therapy. It can accomplish the spectral detection in the range from 380 to 780 nm, with a spectral resolution of 1 nm. Experiments were performed for patients with various age and pigment diseases; finally, some influencing factors and relevant solutions are enumerated and discussed.

Objective: To explore the expression of the vascular cell adhesion molecule 1 (VCAM-1) in the acellular dermal matrix grafting in pigs., Methods: Experimental models were established with 15 Inbred Strain mini pigs, 6 full-thichness skin defect wounds, 6 cm x 6 cm in size, were produced on both-side backs of the each pig, and then the pigs were randomly divided into 3 groups. In Group A (n = 5, control) the thin auto-skin transplantation alone was made; in Group B (n = 5), the grafting was performed in the acellular allo-dermal matrix combined with the thin auto-skins; in Group C (n = 5), the grafting was performed in the acellular xeno-dermal matrix combined with the thin auto-skins. The areas of the wounds were measured and the survival condition of the grafted skins was observed at 3, 9, 21 and 30 days after the grafting. The histological samples were harvested from the grafting area at 3, 6, 9, 12, 21 and 30 days after the procedure. The flow cytometry was employed to analyze the changes in the VCAM-1 level in the sample at different time points after the grafting., Results: In the 3 groups, the transplanted skin base was easily separated at 3 days after transplantation; the areas of the wound healing accounted for 94Y+/- 12%, 92%+/- 9% , and 91%+/- 11%, respectively, at 21 days; good wound healing was achieved at 30 days. At 9 and 12 days after transplantation, there was an evidently-increased level of the VCAM-1 expression in the tissue samples in the composite skin grafting groups. Compared with the control group, the difference was significant (P < 0.05); however, the VCAM-1 expression at 3 days was not statistically different between the composite skin grafting groups and the control group after transplantation. In contrast, the level of the VCAM-1 expression was significantly higher at 6 days in the control group than in the composite skin grafting groups (P < 0.05). The levels of the VCAM-1 expression were significantly lower at 30 days than at 3 days after transplantation in all the 3 groups (P < 0.01)., Conclusion: The highest level of the VCAM-1 expression can be delayed in the composite skin grafting when compared with that in the thin auto-skins alone, which implies that the VCAM-1 expression may be correlated with angiogenesis and composite skin survival. The VCAM-1 expression is not different between the acellular allo-dermal matrix composite skin grafting groups and the acellular xeno-dermal matrix group.

Objective: To evaluate the clinical effect of external tissue expansion in the repair of massive skin and soft tissue defects., Methods: From August 1998 to January 2004, 10 patients with massive skin and soft tissue defects ( the area ranging from 10 cm x 4 cm to 24 cm x 15 cm) , including 7 with wounds in the leg, 2 with wounds in knee region, and 1 with wounds in the forearm, were enrolled in the study. All patients were subjected to external tissue expansion together with external skeletal fixation for 2 -3 weeks, then the wounds were closed with suturing or supplemented with skin flaps., Results: The defects were closed completely after external expansion in 4 cases, and in other 5 cases the wounds were significantly decreased in area, and the residual wounds were covered with free skin grafting. In I case the wound could only be reduced in size, and the residual wound was closed with a local flap. Follow-up from 1 to 12 months showed that the wounds were closed with normal cutaneous sensation and good appearance., Conclusion: External skin expansion is a simple, economical method for repair of massive skin soft-tissue defect, which can significantly be reduced or entirely closed.

Objectives: To investigate the clinical therapeutic effect of tibial bone-skin flaps in the repair of infective bone-skin defects of the leg., Methods: Between February 2000 and March 2005, 68 cases of leg infective wounds with tibial bone and skin defects were treated: 4 cases using free grafting, 64 cases using cross-leg or ipsilateral transposition grafting of tibial bone-skin flaps so that the tibial support continuity of the affected leg could be reconstructed and the wound could be covered at one stage. The skin flap area ranged from 9 cm x 4 cm to 25 cm x 12 cm and the bone flap length ranged from 6 cm to 21 cm., Results: The flaps were completely survived in 67 of the 68 cases except 1 case which was repaired by fibular bone-skin flaps because of the failed blood-vessel anastomosis; the bone flaps were healed in 66 cases, except 1 case which had delayed union of the proximal end through 6-month follow-up because tibial bone flap was lengthened, leading to long soft tissue stripping of the proximal end. All the 68 patients were followed up 6 months to 5 years. The leg function and contour were satisfactory 2 years after operation. Those patients followed up more than 2 years showed normal weight loading walking without obviously abnormal gait, and can engaged in original work., Conclusion: On the basis of sufficient anti-infection, the one-stage reconstruction of tibial support continuity and the covering of wound by the three methods are suitable for many types of leg bone and skin defects, have a great application value and high successful rate and can retain the affected limb and create the conditions for the functional recovery.

Objective: To evaluate a new reconstruction method for grades V and VI defect with flap by skin soft tissue expansion technique., Methods: From May 1998 to September 2003, 8 cases of serious thumb defect were treated, including 6 males and 2 females, aging 18-27 years. The defect was caused by crush injury of machine in 6 cases and hot crush injury in 2 cases (5 cases of grade V and 3 cases of grade VI). The expander was placed under the tenor skin and soft-tissue. And then normal saline was infused to expand the skin and soft tissue gradually till it was available for thumb reconstruction. Iliac autograft was fixed to residual thumb stump and covered with flap produce by expanded skin and soft-tissue. Postoperative rehabilitation was carried out., Results: All reconstructed thumbs were alive. After 3-24 months follow-up, all reconstructed thumbs were with good sensation, appearance and durable. Two-point discrimination was less than 5 mm. The functions of opposition, extend, abduction and endoduction were better in grade V thumb defect than in grade VI thumb defect. Bone union was achieved within 3 to 4 months., Conclusion: It is a convenient-to-operate and reliable method for thumb reconstruction. It is an alternative new reconstruction method for grades V and VI, thumb defect.

Objective: The study was to evaluate the microscopic changes on skin and soft tissue after repeated expansion for clinical work., Methods: Six little pigs were divideded as: conventional expansion group, repeated expansion group, and blank control group. Histologic, ultrastructure and bFGF of the skin were observed and measured in each group after samples had been made., Results: The skin and soft tissue after repeated expansion were healthy on the whole. Compared with the conventional expansion group, there was more microscopic change in the repeated expansion group. Collagen fibers were injured evidently. Cells were injured slightly and proliferated much more, and moreover, they were more activated. The content of bFGF was more higher., Conclusions: The skin and soft tissue after repeated expansion are healthy on the whole by more growth and more repair though repeated expansion may result in more injuries. So repeated expansion is safe and feasible.

Objective: To investigate the outcome of repairing hand composite defects using pedicle osteocutaneous groin flap., Methods: From February 1998 to May 2004, 33 cases of hand composite defects were repaired with pedicle osteocutaneous groin flap. There were 22 males and 11 females. The age was 19 to 54 years with an average of 24.3 years. The defect was caused by palmar penetrating injury in 17 cases, by dorsal hand crushing injury in 9 cases and by other injury in 7 cases. Twenty-three cases complicated by metacarpal defect, 10 by phalanx defect. The size of skin defect was 3. 5 cm X 2.0 cm to 15.0 cm X 10.0 cm, the size of bone defect was 1.5 to 3.5 cm. After 3 to 7 days of primary debridement, defect was repaired by the pedicle osteocutaneous groin flap based on the superficial circumflex iliac vessels. The flap size was 4.0 cm X 2.5 cm to 17.0 cm X 11.0 cm., Results: All the osteocutaneous flaps survived. During the 4 to 22 months follow-up postoperatively, the texture, appearance and function of the flap were excellent and bone union was obtained in all cases after 7 to 9 weeks of operation., Conclusion: The pedicle osteocutaneous groin flap is an ideal flap to repair the composite defect of the hand, with the benefit of simple procedure and reliable blood supply.

Objective: To evaluate the feasibility and effect of mesenchymal stem cells (MSCs)-poly (lactic-co-glycolic acid) (PLGA) scaffold as transplant in repair of skin damage., Methods: MSCs were isolated from the bone marrow of femur of a one-month-old New Zealand rabbit, cultured, and labeled with diamidino-phenyl-indole (DAPI). Porous foam scaffolds were made with PLGA. MSCs of 2 - 3 passages were seeded on the scaffolds. Fluorescence microscopy and scanning electron microscopy were used to observe the growth of the MSCs. Six pieces of skin 2 cm x 2 cm in size were cut from the backs of five 5-month-old new Zealand rabbits and then 4 pieces of MSCs- PLGA scaffolds and 2 pieces of porous foam PLGA scaffolds of the size similar to these of the cut skin were transplanted to the skin wounds. The wound healing was observed. Five days after the operation, samples of newly-grown skin were taken to undergo HE staining, VG staining, and microscopy. Immunofluorescence histochemistry was used to detect the cytokeratin AE1/AE3., Results: Scanning electron microscopy showed that holes were distributed evenly on the surface of and inside the porous foam PLGA scaffolds Fluorescence microscopy and scanning electron microscopy showed that the MSCs grew well on the porous foam PLGA scaffolds and the number of MSCs increased gradually. Animal experiment showed that with the degradation of the polymer scaffolds the wounds were gradually covered by newly grown skin similar to the normal skin. Immunofluorescence histochemistry showed fluorescence positive cells in the stratum corneum and follicles. The wounds transplanted only with porous foam PLGA scaffolds formed new skin too, however, in the dermis of the new skin only thickened fibrous scars and a few follicles were seen., Conclusion: The compound of MSCs-PLGA polymer is effective in wound healing.

Objective: To investigate the application of arm medial fascio-cutaneous flap pedicled with cutaneous nerve and nutrient vessel., Methods: From February 1999 to December 2004, 18 cases of skin and soft tissue defect in axillary region, elbow and forearm were treated with arm medial fascio-cutaneous flap pedicled with cutaneous nerve and nutrient vessel. Arm medial fascio-cutaneous flap was directly transferred in 3 cases, adversely transferred in 15 cases. The flap area was 4.5 cm x 8.5 cm., Results: Vein circulation crisis was observed in 3 cases. Of the 3 cases, 1 was necrosis and the other 2 by decompressing small vein were saved. The rest 15 cases survived. The period of follow-up was 3 to 30 months. Flap was satisfactory in appearance and function., Conclusion: Arm medial fasciocutaneous flap pedicled with cutaneous nerve and nutrient vessels can be directly or adversely transferred to repair adjacent soft tissue defect.

Objective: To introduce the surgical procedure and indication of the reverse fascial pedicle island flap of the digital artery dorsal branches in repairing finger skin defect., Methods: By use of the dorsal branches of the digital artery as the pedicel, the reverse island flap was designed. The skin defects of the proximal interphalangeal joint and beyond in 35 cases (42 fingers) were repaired and the joint or extensor tendon was reconstructed simultaneously. Donor site was primarily closed or a skin graft was used. The flap size ranged from 1.0 cm x 2.5 cm to 1.5 cm x 3.5 cm., Results: Thirty-five patients were followed up 3 months to 1 year, all the flaps survived. The two-point discrimination was between 6 mm and 10 mm. The function of interphalangeal joint was satisfactory., Conclusion: These flaps have the advantages of an extended skin paddle and a versatile pivot point on the phalanx, and they allow coverage of wide and distal defects.

Objective: To investigate the diagnosis and differential diagnosis of extranodal Rosai-Dorfman disease., Methods: Two cases of extranodal Rosai-Dorfman disease were studied using hematoxylin-eosin, and immunohistochemical staining, along with a literature review., Results: The lesions of RDD were characterized by the presence of large histiocytes with emperipolesis, accompanied by infiltration of lymphocytes, plasma cells and other inflammatory cells. The large histiocytes had an abundant cytoplasm, pale to eosinophilic in appearance, positive for S-100 protein staining, with a vesicular nucleus and a small basophilic nucleolus in each cell., Conclusions: Extranodal Rosai-Dorfman disease is known as an idiopathic proliferative disease of histiocytes with a distinct morphologic feature and is very rare. Differential diagnosis from other types of fibrohistiocytic proliferation lesions is recommended.

Objective: To study the therapeutical effect of the tangential excision of razor graft for the spacious giant congenital naevi in children., Methods: The surface layer of the giant naevi, mainly razor graft, was excised tangentially using electrical dermatome. Then the left naevi was removed by dermabrasion., Results: The satisfactory effects were obtained in 9 of 16 cases. The colour of operative area approached the normal skin, occasionally with scattered pigmentation and hypertrophic scars. In 6 cases, the colour appeared lighter than before. One case relapsed after half a year., Conclusions: The congenital giant naevi in children could be treated using the tangential excision of razor graft. The short-term results might be expected.

Objective: To investigate the results of human amniotic membrane (HAM) which are loaded with marrow mesenchymal stem cells (MSCs) and epidermis cells in treating full-thickness skin defect combined with radiation injury., Methods: Eight minipigs were used in this study. Three round full-thickness wounds (phi3.67cm), which combined with radiation injury, were created on the dorsum of each side close to the vertebral column in each animal. Among 48 wounds, 24 left side wounds were treated with HAM loaded with MSCs and epidermis cells as experimental group (group A), 16 right side wounds with simple HAM (HAM group, group B) and 8 right side wounds with oil gauze as control (group C). The granulation tissue, reepithelization and wound area were observed after 1,2 and 3 weeks. Immunohistochemistry was performed using vWF as a marker for blood vessels. Image analysis was employed to test new area of wound at different interval time and healing rate of wound., Results: The healing time of group A was 6 to 7 days faster than that of group C and 5 to 6 days fister than that of group B. After 15-17 days of graft, there were significant differences in new area of wound and healing rate between group A and groups B, C (P < 0. 01). New epidermis fully covered whole wound surface in group A, and their granulation tissue, which contained a lot of vWF, fibroblasts, capillaries and collagen, grew well. Many inflammatory cells still were seen in groups B and C, and their contents of vWF, fibroblasts, capillaries and collagen in granulation tissue were smaller than that in group A., Conclusion: The graft of HAM loaded with MSCs and epidermis cells played an effective role in promoting healing of wound combined radiation injury with high quality.

Objective: To construct a tissue engineering skin containing capillary-like network by employing tissue engineering method., Methods: The numan umbilical vein endothelial cells(HUVECs) were isolated from a new-born umbilical cord. The keratinocytes and dermal fibroblasts were isolated from a new-born foreskin biopsy. After the collagen gel was prepared, the fibroblasts and the vascular endothelial cells were added in a ratio of 1 to 1 to construct a skin substitute containing capillary-like network. The skin substitute was observed by HE staining and immuno histochemical staining (VIII factor). The reconstructed skin containing capillary-like network was used to repair the nude mice skin defects in the experimental group. The tissue engineering skin containing no vascular endothelial cells was used in control group., Results: Capillary-like network could be observed in the dermal layer of the tissue engineering skin, and the nude mice skin defects were repaired by the skin substitutes in the experimental group. In control group, no capillary-like network was found., Conclusion: The tissue engineering skin containing capillary-like network is successfully constructed in vitro and can be used to repair the full-thickness skin defects.

Objective: To evaluate a method to repair the defects after the secondary tumor excision and radiation ulcer in the chest, back and axilla., Methods: Eight patients, with the defects after the secondary tumor excision and the radiation ulcer in the chest, back and axilla, were undergoing the treatment. A "T" shape incision or up-side-down "T" shape incision was designed above the breast or along the inframammary fold below breast, just close to the defect. A split-breast flap was raised above the pectoralis major or deep fascia. The defect was then repaired with a rotating and advancing way., Results: Eight patients were repaired in one stage. Blood circulation of the flaps was abundant except one with distal edge necrosis. The ptosis breast was corrected and the fullness of the chest wall was also achieved. But, the Nipple of the opposite health breast was lost the original position to the lateral or medial., Conclusions: The above-mentioned technique may be an efficient method to repair the defects after the secondary tumor excision and radiation ulcer in the chest, back and axilla. It is adapt to the old patients whose health is worse, but it is not good for the young patients resulted from the injury breast.

Objective: To study a new effective approach which repairs large defects of skin and soft tissue in neck and face., Method: This procedure accomplishes repetitive sub-platysmal expansion to form large musculocutaneous flap with underlying pedicel. The surgeon slides it toward neck and face to repair the defects of skin and soft tissue., Result: Eleven patients, who had such defects in neck, face, cheek, chin or submental skin and soft tissue, underwent this treatment. All the flaps survive with no complications of blood supply deficiency or necrosis. The short-term and long-term results are both satisfying., Conclusion: This method, making repetitive sub-platysmal expansion to form musculocutaneous flap and then slide it toward neck/face to repair large defects of skin and soft tissue, proves to be safe and reliable. And appropriate cases and strict operations are important.

Objective: To study the polypropylene mesh acted for the moulding and support., Methods: Four mini-pigs were used in this experimental research. A polypropylene mesh was implanted under the skin on one side of each pig. An expander was thereafter placed in the deep layer to imitate the action of gravity to the skin and mesh. The specimens were collected in two different times for the biomechanics and histology examinations., Results: The biomechanical data were shown lower and the histological properties were found changeable in the expanded skin without the mesh support, compared with the normal skin. However, the changes did not occur in the expanded skin with the mesh support. Furthermore, the tensile strength and elastic modulus of the polypropylene mesh were significant less than the human skin., Conclusion: The Polypropylene mesh could prevent the extended skin effectively and has moulding and support effects.

Objective: To evaluate the effects of cryopreserved cultured allogenic dermal fibroblasts on angiogenesis and fibroplasia while artificial dermis grafting by spraying the cells on the graft bed., Methods: Full thickness skin defect was made on the back of Wistar rat, fibroblasts mixed into fibrin glue (fibroblast group) and same amount fibrin glue (control group) were sprayed separately between the wound bed and artificial dermis in cell density of 1.0 x 10(5) cells/cm2 before the artificial dermis was grafted. On day 5 after grafting, the graft and surrounding tissue were examined histologically for angiogenesis and fibroplasia in the dermis and wound bed with hematoxylin eosin stain, VEGF antibody stain, Masson's trichrome stain and India ink stain. Evans blue perfusion method was also used for detecting the angiogenesis quantitatively., Results: In the fibroblast group, the angiogenesis of graft bed was significantly accelerated on day 5 after grafting; the numbers of the newly formed capillaries were 9.64 +/- 2.36/HP in the fibroblast group and 3.88 +/- 1.62/HP in the control group (P < 0.05). And on day 10 after grafting the angiogenesis was accelerated not only in graft bed but also in the artificial dermis when compared with control group, the newly formed capillaries network was clearly observed in the artificial dermis. Otherwise, the synthesis of collagen was increased in the dermis on day 10 after grafting in the fibroblast group when compared with control group. The immunoreactivity of VEGF antibody in the fibroblast group also showed a stronger expression than that in control group on day 5 after grafting, the numbers of positive cells were 46.04 +/- 8.90/HP in the fibroblast group and 30.08 +/- 7.76/HP in the control group(P < 0.05)., Conclusion: Transplantation of cryopreserved dermal fibroblasts while artificial dermis grafting can accelerate the angiogenesis and fibroplasia in the artificial dermis and graft bed, thereby accelerate the formation of dermal-like tissue in the artificial dermis.

Objective: To enlarge the ratio of length to width of a prefabricated random skin flap in a short period, in order to meet a special clinical need., Methods: A white rat and a white mini-pig was chosen for an animal model for the experiment. They were divided into the experimental group and the control. The prefabricated flap was formed as the planned design. In the experimental group, the flaps were treated with a desired pressure in certain intervals at the planned part of the flap. We estimated and inspected the digitized perfusion of flap microcirculation, and made overcong and wide random skin flap survive within 24 hours, and this technique was finally used for the clinical wound treatment., Results: As expected, the survival area of the flap in the experimental group was significantly larger than the control. This technique was successfully used to repair the defects of the special sites in plastic and reconstructive surgery., Conclusion: The method of quickly prefabricated random flap could enlarge the ratio of length to width of the flap and put the flap in shape in short time. With the digitized estimating and inspecting, this method could obviously improve the survival area of the random flap and could also be very useful for the clinical treatment.

Objective: To study the curative effects of keloid by operation combined with postoperative beta radiation and silicone gel sheeting., Methods: From 1996 to 2002, 598 patients with keloid (243 males, 355 females, aging 15-55 years with an average of 28.6 years) were treated by integrated therapy. Their disease courses were from 6 months to 6 years. The keloid area ranged from 1.0 cm x 1.5 cm-8.0 cm x 15 cm. First, keloid was removed by operation, and then the wounds were sutured directly (group suture) or covered with skin graft (group graft). In group suture, the operational sites were managed by beta ray radiotherapy 24-48 hours after operation. The total doses of radiation were 12-15 Gy, 5 times 1 week (group suture A) and 10 times 2 weeks (group suture B). Radiotherapy was not taken until stitches were taken out in group graft, and then the same methods were adopted as group suture B. After radiotherapy, silicone gel sheeting was used in 325 cases for 3-6 months., Results: All patients were followed up for 12-18 months. (1) The overall efficacy was 91.3% in group suture A (n = 196), and 95.8% in group suture B (n = 383), respectively. There was significant difference between the two groups (P < 0.01). (2) Radiotherapy was of no effect in 6 cases of group graft (n = 19). (3) Silicone gel sheeting had effectiveness in 185 cases. Silicone gel sheeting had no obvious effect on the overall efficacy, but it could improve the quality of texture and color of skin., Conclusion: By use of integrated methods to treat keloid, if the wound can be sutured directly, skin grafting should not be adopted. The results in group suture B are better than those in group suture A; silicone gel sheeting should be used as possible.

Objective: To build the trestle of tissue engineering for skin with the collagen., Methods: The collagen was obtained from the baby cattle hide pretreated by Na2S and elastinase and Protease M, then the collagen was dissolved in 0.5 mol/L acetic acid solution. The collagen was treated with Protease N to minimize its immunogenicity. The resulting collagen could be used to build the trestle of tissue engineering for skin because of good biocompatibility. The collagen molecular weight and structure were analyzed by SDS-PAGE. The bioactivity of trestle was tested in the experiment of the mice wound healing and the cell implantation., Results: The SDS-PAGE result of the collagen treated by Protease M showed the typical spectrum of type I collagen. The built trestle was a collagen sponge matrix in which micropore size was 50-200 microns. It could accelerate wound healing and the implanted fibroblasts could proliferate well., Conclusion: The collagen treated by Protease N can get good biocompatibilily and is suitable for building the trestles of tissue engineering for skin with good bioactivity.

Objective: To explore the methods of treatment for old achilles tendon rupture merging with skin defect., Methods: By following up retrospectively 10 patients from February 1995 to December 2001, we analyzed the operative methods, the points for attention and the results. Gastrocnemius musculocutaneous flaps were used in 3 cases, foot lateral skin flaps in 4 cases, superior medial malleolus skin flaps in 2 cases, and sural neural skin flap in 1 case. The Achilles tendon was sutured directly in 8 patients, with Lindholm's technique in 2 patients., Results: All flaps survived and the wound healed well in 8 cases and reruptured in 2 cases. According to Yin Qing-shui's criteria to test the efficacy, the results were excellent in 5 patients, good in 4 and poor in 1., Conclusion: Repairing the old Achilles tendon rupture merging with skin defect by use of microsurgery has good results and plays an important role in reducing joint contracture and stiffness, and in saving the ability to push forward and flex.