Objective To summarize the therapeutic effectinevess of incorporating pedicled retrograde flap of forearm transplantation for reconstructing severe contracture of the first web space and wrist. Methods Between November 2005 and February 2010, 26 patients with severe contracture of the first web and wrist were treated. There were 18 males and 8 females with an average age of 27 years (range, 12-45 years). The locations were the right sides in 15 cases and the left sides in 11cases. The injury reason included hot water scald in 7 cases, explosion hurt in 5 cases, traffic accident in 3 cases, hot pressing in 5 cases, and flame burns in 6 cases. The duration of scar contracture ranged from 6 to 26 months with an average of 11 months. According to the evaluation standard by GU Yudong et al., all had severe contracture of the first web space, and concomitant injuries included adduction deformity thumb, l imitation of the thumb extension and opposition function, and carpometacarpal flexion joint deformity. After scar contracture was released, the defect size ranged from 5.8 cm × 4.5 cm to 11.3 cm × 7.2 cm, which were repaired by the incorporating pedicled retrograde flap of forearm of 6.5 cm × 5.0 cm to 12.5 cm × 8.0 cm at size. The donor sites were directly sutured or repaired with skin graft. Results Bl ister and partial necrosis occurred at the distal end of the flaps in 2 cases, which were cured after dressing change. The other flaps survived and wounds healed by first intention. Incisions at donor sites healed by first intention. Twenty-six patients were followed up 6 to 24 months (mean, 15 months). The patients had functional recovery in thumb adduction and opposition at different degrees. At 6 months after operation, according to the Swanson et al. AMA system for total thumb activity, the total thumb function was improved significantly, and according to Jensen et al. measurement, the width and angle of the first web space were significantly increased, all showing significant differences (P lt; 0.05). Conclusion Incorporating pedicled retrograde flap of forearm transplantation for repairing severe contracture of the first web space and wrist could augment the first web space and improve the wrist flexible function.
From July 1978 to July 1990, 11 operative methods for reconstruct the gluteal motors were performed in 733 cases. The result was satisfactory. The authors first introduced the Clinical material, then discussed principally how to selecte the operative type and some technical points to improve the result. It was thought that Obers operation was simple, easy and its result was reliable. So, it was taken as the method of priority in restoring the gluteal motors in this hospital.
ObjectiveTo study the feasibility and advantages of preparing an animal model of defecation reconstruction after spinal cord injury in rats by mechanical polishing method.
MethodsForty adult female Sprague Dawley rats (weighing, 250-300 g) were randomly divided into 2 groups (n=20). The lamina was opened by mechanical polishing method to expose the cauda equina in experimental group, then bilateral L5 and S1 nerve roots end-to-end anastomosis was done under 10 times microscope, and finally cauda equina between the L5 and L6 (except S1) was cut. The lamina was opened by traditional bites method in control group, and the other treatment methods were in agreement with the experimental group. The operative time, intra-operative blood loss, and situation of rats at postoperative 3 days were recorded.
ResultsThe operative time of experimental group[(93.05±7.60) minutes] was significantly shorter than that in control group[(131.30±11.68) minutes] (t=12.279, P=0.000); intra-operative blood loss in experimental group[(4.33±0.46) mL] was significantly lower than that in control group[(7.36±0.58) mL] (t=18.293, P=0.000). At 3 days after operation, 18 rats (90%) survived in experimental group, and 12 rats (60%) survived in control group; difference was significant in the survival rate between 2 groups (χ2=4.800, P=0.028).
ConclusionTo establish an animal model of defecation reconstruction after spinal cord injury in rats by mechanical polishing method is feasible, and it has shorter operative time, less blood loss, and lower postoperative mortality than the traditional bites method. But there is a certain learning curve and requirement to master microsurgical techniques.
Objective To compare the reconstructive method of oral and maxillofacial defect with free tissue flaps. Methods The clinical materials were collected from 1 973 reconstructive cases between January 2000 and June 2004 and analyzed in terms of the distribution of age, gender,disease type, defect location, reconstructive method and the incidence of vascular crisis of free flaps as well as success rate of free flap respectively. SAS 6.12 was adopted for statistical analysis. Results A total of 1 973reconstructive cases includded 764 in middle age (＞45 years to ≤60 years, 38.72%), 527 in old age (＞60 years, 26.71%), 450 young adults (＞28 years to ≤45 years, 2281%), 187 in young age (＞14 years to ≤28 years, 9.48%) and 45 children(≤14 years, 2.28%). The ratio of male to female was 1.5∶1. The ratio of benign to malignancy lesion was 1∶1.94. The tongue defect accounted for 20.63%, followed by mandibular defect(1738%), parotid defect(13.74%)，buccal defect(12.72%), maxillary defect(8.16%), oral pharynx defect (7.60%), floor of mouth defect(5.68%) and others (14.09%). Vascular free flap transfers accounted for 45.82%(90.4), followed by axial flap(38.17%,753), random flap(10.19%,201), avascularizedbone graft (1.52%, 30) and others(4.30%, 85). The most frequently used flap was the forearm flap(594 cases), followed by the fibula free flap(143 cases) and the pedicled pectoralis major myocutaneous flap(369 cases); these three flaps accounted for 56.06% (1 106/1 973).In 47 free tissue flaps(5.20%) having vascular crisis, 30 were saved (63.83%). The success rate of total free tissue flaps was 98.19%(923/940). Conclusion The majority of reconstructive cases of oral and maxillofacial defects is the middle aged andthe old aged male patients with malignancy. The tongue defect accounts for about one fifth of all the cases. The vascularized free flap has a high success rate, so it is a main method for reconstruction of oral and maxillofacial defects. The forearm flap, the fibular free flap and the pedicled pectoralis major myocutaneous flap are the main management for repairing oral and maxillofacial defects.
Objective To introduce the recent advances of the application of computer technology in tissue engineering. Methods The recent original articlesrelated to computer technology, medical image technology, computer-aided design, the advanced manufacture technology were summarized and systematically analyzed.Results Computer-aided tissue engineering is a new fieldon tissue engineering. It is the future direction of tissue engineering study. This article reviews recent development of medical CT/MRI scanning, three-dimensional reconstruction, anatomical modeling, computeraided design, computer-aided manufacturing, rapid prototyping， RP manufacturing of tissue engineering scaffolds and computeraided implantation.Conclusion Computer-aided tissue engineering can be used in scaffolds design and fabrication, computer-aided artificial tissue implantation. It is a new field on tissue engineering.
Surgical management of non-small cell lung cancer (NSCLC) invading chest wall is the combination of pulmonary resection, lymphadenectomy and chest wall resection and reconstruction. Hitherto the surgical procedures include combination of thoracotomy and video-assisted thoracoscopic surgery (VATS), thoracotomy, and VATS. The result of the surgery leads to a defect in the chest wall. Therefore, the requirements of the technique and material are relatively high with no consensual standard. This review describes the definitions, indications, materials, prognostic factors, and recent progress in surgical techniques.
OBJECTIVE To emphasize the importance of reconstruction and repair after resection of soft tissue sarcoma. METHODS From November 1990 to November 1996, in 107 cases of soft tissue sarcoma 32 cases had received various reconstructive or reparative operations. Among the 32 cases, 4 cases were primary sarcomas and 28 cases were recurrent sarcomas. In surgical grading, 3 cases were of I B, 3 cases of II A and 26 cases of II B. Radical resection was performed in 13 cases, widen local resection in 17 cases and local excision in 2 cases. After operation, 13 cases received chemotherapy and 7 cases received radiotherapy. Reconstruction of blood vessels was performed in 3 cases, reconstruction of kinetic function in 16 cases, and repair of defect was carried out in 23 cases. RESULTS Thirty patients were followed up for 4 months to 6 years and 6 months. The clinical results showed that the local control rate of sarcoma was 80%, limb-salvage rate after reconstruction of blood vessels was 100%, the excellent and good rate after reconstruction of kinetic function was 87.5%, and the survival rate of the tissue flap of transplantation and transposition was 96%. CONCLUSION It was concluded that the reconstruction and repair after resection of soft tissue sarcoma was the extension of operative treatment, and was very important in lowering the recurrence rate and improving the life quality of the sufferings.
Objective To compare the effectiveness of proximal femoral nail antirotation (PFNA) and reconstruction nail with minimally invasive technique for ipsilateral femoral shaft and extracapsular hip fractures in young and middle-aged patients. Methods Sixty-nine young and middle-aged patients with ipsilateral femoral shaft and extracapsular hip fractures were treated between January 2000 and August 2010, and their data were analyzed retrospectively. Of them, fractures were fixed by reconstruction nail in 44 cases (reconstruction nail group) and by PFNA in 25 cases (PFNA group). There was no significant difference in gender, age, weight, injury cause, fracture type, or disease duration between 2 groups (P gt; 0.05). The operation time, blood loss, fracture healing time, complications, and functional outcomes were compared between 2 groups to evaluate the effectiveness. Results The operation time and blood loss in the PFNA group were significantly less than those in the reconstruction nail group (P lt; 0.05). The follow-up time was 12-38 months (mean, 20 months ) in the PFNA group and was 12-48 months (mean, 22 months) in the reconstruction nail group. No complication occurred as follows in 2 groups: wound infection, deep venous thrombosis, pulmonary embolism, breakage of the implants, avascular necrosis of the femoral head, or serious rotation and shortening deformity of lower limbs. In the PFNA group and the reconstruction nail group, 1 patient underwent technical difficulty in nail implant and 7 patients underwent technical difficulty in proximal locking screw, respectively; 3 patients and 6 patients had intra-operative iatrogenic fracture of femoral shaft, respectively; and delayed union of femoral shaft was observed in 1 patient and 2 patients, respectively. The complication rate was 20% (5/25) in the PFNA group and 34% (15/44) in the reconstruction nail group, showing no significant difference (χ2=1.538, P=0.215). No significant difference was found in fracture healing time between 2 groups (P gt; 0.05). At last follow-up, there was no significant difference in Harris hip score and Evanich knee score between 2 groups (P gt; 0.05). Conclusion PFNA or reconstruction nail with minimally invasive technique is a good method to treat ipsilateral femoral shaft and extracapsular hip fractures, but the PFNA is superior to the reconstruction nail because of simple operation.
