Objective To evaluate a modified anterolateral thigh fascial flap designed for the treatment of the soft tissue defects in the forearmsand hands. Methods From September 2000 to December 2003, a modified anterolateral thigh fascial flap combined with the intermediate split thickness skin graft was applied to the treatment of 13 patients with the soft tissue defects in the forearms or the hands. There were 8 males and 5 females, aged 19-43 years (average, 27.6 years). Three patients had a mangled injury, 4 had a belt injury, and 6 had a crush injury; 6 patients had their tissue defects on the palm side of the forearm, 6 had their tissue defects on the dorsal side of thehand, and 1 had the defect in the index finger (dorsal side of the hand). The tissue defects ranged in size from 17.5 cm×7.7 cm to 4.6 cm×3.4 cm.In addition, 4 of the patients had an accompanying fracture in the forearm or the hand,and the remaining 9 had an extenor tendon injury. All the patients underwent emergency debridement and reposition with an internal fixation for the fracture; 3-5 days after the repair of the injured nerves, muscle tendons and blood vessels, the tissue defects were repaired with the anterolateral thigh fascial flap combined with the intermediate split thickness skin graft. Results No vascular crisis developed after operation. All the flaps survived except one flap that developed a parial skin necrosis (2.0 cm ×1.0 cm) in the hand, but the skin survived after another skingrafting. The follow-up for 3-12 months revealed that all the flaps and skin grafts had a good appearance with no contracture of the skin. According to the evaluation criteria for the upper limbs recommended by the Hand Society of Chinese Medical Association, 9 patients had an excellent result, 2 had a good result, 1 had a fair result, and 1 had a poor result, with a good/excellence rate of 85%. Conclusion The modified anterolateral thigh fascial flap combined with the skin graft is one of the best methods for the treatment of the soft tissue defects in the forearms and the hands. This method has advantages of no requirement for a further flap reconstruction, no skin scar or contracture in the future, easy management for the donor site, and less wound formation.
Objective To detect the expression of melanocortin 1 receptor (MC-1R) and the melanin contents in human skin autografts and the normal skin, to elucide the role of MC-1R in hyperpigmented process of skin autografts. Methods Skin autografts and normal skin samples were obtained from skin graft on neck who need reoperation to release contractures after 1 year of operations. Immunohistochemical technique was performed to detect the expression and distribution of MC-1R in skin autografts(include full thickenss skin autografts, medium thickness skin autografts, and razorthin skin autografts) and normal skin respectively. MassonFontana staining technique was performedto detect the melanin contents in all sorts specimens respectively. Results The expression of MC-1R was located on cell membrane and cytoplasm of melanocyte and keratinocyte in epidermal. The expression of MC-1R in most skin autografts was much ber than that of control normal skins; the thinnerskin autografts were, the more obvious expressions of MC-1R in skin autografts were. The expressions of MC-1R in all sorts of skinautografts were of significant differences compared with that in normal skins(P＜0.01); the expression of MC-1R in normal skin of donor area was no significant differences compared with normal skin around recipient area(P＞0.01). The contents of melanin in skin autografts were increased obviously and there were significantdifferences compared with that in normal skins(P＜0.01); the contents of melanin among all sorts of skin autografts were of significant differences (P＜0.01). The thinner skin autografts were, the more melanin contents in skin autografts. The expression of MC-1R was positively correlated with the contents ofmelanin in epidermis. Conclusion The expression of MC-1R in skin autografts is significantly higher than that in normal skin and is correlated positively with the contents of melanin in skin autografts. Overexpression of MC-1R may play an important role in hyperpigmented process of skin autografts.
【Abstract】 Objective To explore the effect of early scrotal dermatoplasty on spermatogenic functional rehabilitation of testis in juvenile pigs with third degree burn wound of the scrotum. Methods Thirty healthy male Guizhou miniature pigs (weighing 10-15 kg, 2-month-old) were divided into 3 groups: control group (group A, n=10), natural healing group (group B, n=10), and dermatoplasty group (group C, n=10). In group A, the pig was not given any treatment; after third degree burn model of the scrotum was prepared, wounds were not treated in group B and the burn skin was excised and whole hypogastric pachydermia was used for dermatoplasty in group C. At 3 months and 1 year after model preparation, bilateral testis were collected from 5 pigs, respectively. HE staining was performed to observe the effects of different repair method on the morphology of spermatogenic cells and immunohistochemical staining was used to detect Survivin protein expression. Results All pigs survived to the end of the experiment and the wound healed successfully. Histological observation showed that spermatogenic cells had normal shape at all stages and mature sperms were seen in lumens in group A; the thickness of seminiferous epithelium was thinner, having one layer or two layers of spermatogenic cells in group B; the spermatogenic cells in group C were slightly more than that in group B with some spermatids; and in groups B and C, the spermatogenic cells at 1 year were more than that at 3 months. Immunohistochemistry staining showed that the Survivin protein expression in groups B and C was less than in group A, and group B was less than group C, showing significant differences at 3 months and 1 year (P lt; 0.05), but no significant difference between 3 months and 1 year in the same group (P gt; 0.05). Conclusion Dermatoplasty has inhibitory effect on spermatogenic functional rehabilitation of testis. Dermatoplasty can decrease spermatogenic cells and reduce Survivin protein expression, but some spermatids still survive in seminiferous tubule.
【Abstract】 Objective To investigate the effects of different surgical methods in treating scalp mal ignanttumors. Methods From January 1995 to September 2004, 70 patients with scalp mal ignant tumor were treated with different surgical methods. There were 41 males and 29 females with an average age of 50.3 years (30-85 years). The course of disease ranged from 2 weeks to 3 years(mean 3.5 months). There were 31 cases of basal cell carcinoma, 24 cases of squamous carcinoma, 8 cases of melanocarcinoma, 4 cases of fibrous sarcoma, 2 cases of l iposarcoma, and 1 case of vasculosarcoma. Leision size ranged from 1.0 cm × 0.5 cm to 10.0 cm × 8.0 cm. Scalp defect ranged from 3 cm × 3 cm to 12 cm × 11 cm after clearing up the tumors. Defect was repaired with free skin transplantation in 51 cases, scalp flap in 12 cases, cervico-shoulder flap in 2 cases, trapizius myocutaneous flap in 3 cases, and radial artery retro-island flap in 2 cases. The flap sizes ranged from 5 cm × 4 cm to 18 cm × 12 cm. Results Of 70 cases, 67 skin flaps survived and incision healed by first intention; 2 flaps necrosed at distal part(lt; 1 cm) and healed by second intention after dressing change; 1 flap infected and was treated with symptomatic medication.All the donor sites healed by first intention. Fifty-five patients were followed up for 1 to 5 years and 5 cases had tumor recurrence. In patients receiving skin transplantation, 1 case of squamous carcinoma and 1 case of fibrous sarcoma relapsed after 1 year and 2.5 years respectively and were given radical resection and skin flap grafting; in patients receiving skin flap grafting, 1 case of vasculosarcoma and 1 case of squamous carcinoma relapsed after 6 months and 3 months respectively, and gave up treatment; 1 case of fibrous sarcoma relapsed after 2 years and was given radical resection and skin flap grafting. The other cases survived and had no tumor recurrence. Conclusion Scalp mal ignant tumors should be diagnosised and treated as early as possible. Clearing up completely by surgery is an effective method.
Objective
To evaluate the clinical outcomes of free perforator flaps combined with skin graft for reconstruction of ankle and foot soft tissue defects.
Methods
Between June 2014 and October 2015, 20 cases of ankle and foot soft tissue defects were treated. There were 16 males and 4 females, aged from 19 to 61 years (mean, 43.3 years). Injury was caused by traffic accident in 7 cases, by crashing in 9 cases, and machine twist in 4 cases. The locations were the ankle in 6 cases, the heel in 3 cases, the dorsum pedis in 4 cases, and the plantar forefoot in 7 cases of avulsion injury after toes amputation. The size of wound ranged from 15 cm×10 cm to 27 cm×18 cm. The time from injury to treatment was from 11 to 52 days (mean, 27 days). The anterolateral thigh perforator flap was used in 11 cases, thoracodorsal antery perforator flap in 3 cases, medial sural artery perforator flap in 4 cases, deep inferior epigastric perforator flap in 1 case, and anteromedial thigh perforator flap in 1 case, including 5 chimeric perforator flaps, 5 polyfoliate perforator flaps, 3 flow-through perforator flaps, and 3 conjoined perforator flaps. The size of the perforator flap ranged from 10.0 cm×6.5 cm to 36.0 cm×8.0 cm, the size of skin graft from 5 cm×3 cm to 18 cm×12 cm.
Results
Venous crisis occurred in 2 flaps which survived after symptomatic treatment; 18 flaps survived successfully and skin grafting healed well. The follow-up time ranged 4-18 months (mean, 8.3 months). The flaps had good appearance, texture and color, without infection. The patients could walk normally and do daily activities. Only linear scars were observed at the donor sites.
Conclusion
Free perforator flap can be used to reconstruct defects in the ankle and foot, especially in the weight-bearing area of the plantar forefoot. A combination of free perforator flap and skin graft is ideal in reconstruction of great soft tissue defects in the ankle and foot.
