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Objective: To evaluate the effectiveness of double pedicled flap and technique of geometric broken line (GBL) for primary repair of serious dog bite wound., Methods: Between October 2006 and December 2014, 9 patients with serious dog bite wound were treated. There were 3 males and 6 females with an average age of 34.5 years (range, 8-68 years), and with a mean disease duration of 4 hours (range, 30 minutes to 24 hours). The defect ranged from 1.7 cm×0.5 cm to 15.0 cm×8.0 cm, with the mean depth of 0.5 cm (range, 0.3-0.8 cm). Deep tissue exposure was observed. After routine debridement, a vacuum sealing drainage (VSD) was equipped to suck and irrigate for 1 day, then wound was repaired. The superomedial edge of defect was trimmed, then a GBL shape mainly with square and rectangular was designed. According to defect size, a double pedicled flap was designed at the lateroinferior edge of defect, which size ranged from 1.7 cm×1.5 cm to 18.0 cm×15.0 cm. The donor site was sutured directly. VSD was used for 3 days after operation., Results: All flaps survived and wound healed, and donor site incision healed well, with invisible scar. All patients were followed up 6 months to 8 years (mean, 4 years). The wounds were repaired well, and the patients had good facial appearance. No rabies attack was observed during follow-up., Conclusions: It is an ideal repair method to chose double pedicled flap and technique of GBL for primary repair of dog bite wounds. Satisfactory cosmetic appearance can be obtained.

Objective: To evaluate the dynamic change of CD34 level during the survival process of narrow pedicle flaps., Methods: Twenty-five white pigs were randomly and equally divided into 5 experimental groups. Five different type of narrow pedicle with different length-to-width ratio were employed, and each type of narrow pedicle was covered with 5 different size random flaps and which was classified into A, B, C, D and E for 5 groups. Group A was control group. Each type narrow pedicle with 5 different skin flaps were implanted onto the back of the pigs along the midline of back with a reverse direction. A 0.3 cm×0.3 cm full thickness skin flap in the middle of distal segment was collected and on 3rd, 5th, 7th and 14th days of post-operation. The expression of CD34 was measured by immunohistochemistry and enzyme-linked immunosorbent (ELISA)., Results: Histological examination showed that with the increasing of length-to-width ratio of the narrow pedicle skin flaps, the expression of CD34 increased in the skin flaps. Increased level of CD34 was found on 3rd day post-operation, and the peak expression was found on 7th day. Persistent high level of CD34 was found until 14th day., Conclusion: Increased CD34 level in the distal skin flap, there is the association between CD34 level and ischemia injury. Moreover, CD34 expression plays an important role during the repair processes of pedicle flaps.

Objective: To investigate the technique and effectiveness of using narrow hypodermal pedicled retroauricular flap for repairing preauricular soft tissue defect., Methods: Between June 2008 and July 2011, 11 cases of preauricular soft tissue defect were treated, which were caused by resection of preauricular tumors, including 5 cases of pigmented nevus, 2 cases of basal cell carcinoma, 2 cases of mixed hemangioma, and 2 cases of skin papilloma. There were 7 males and 4 females, aged from 26 to 75 years (mean, 50 years). The disease duration was 3-50 years (mean, 35 years). The size of the soft tissue defect ranged from 1.5 cm x 1.0 cm to 3.5 cm x 3.0 cm. The narrow hypodermal pedicled retroauricular flap was designed with its pedicle along the pathway of the superficial temporal artery and posterior auricular artery through tunnel to repair the defects. The size of the flaps ranged from 1.8 cm x 1.3 cm to 3.8 cm x 3.3 cm with the pedicle of 2-5 cm in length and 0.4-0.7 cm in width. The donor site was sutured directly or repaired with local flap., Results: All flaps survived and incisions healed primarily after operation. Eight cases were followed up 6 months to 1 year. The flaps had good texture, flexibility, and color, and the auricle appearance was satisfactory. No recurrence of tumor was found., Conclusion: The narrow hypodermal pedicled retroauricular flap has long and narrow pedicle, big transferring angle, large repairing area, no major blood vessel, and easy operation, so it is a simple and ideal technique for repairing preauricular soft tissue defect.