Two hundred and twenty-two toes to hands free transfers have been performed in our clinic from January 1973 to May 1992 with a 100 percent successful results obtained. The authors developed the extended toe free transfer technique,and this technique was used in 40 cases.Six types of extended toe transfer can be designed to carry out complicated thumb or other finger reconstructions.Keys to successful toe-to-hand transfers are as followings: Evaluation of a three-points and one line pulsation on the donor foot can be used to localize the course of the first dorsal metatarsal artery . The first dorsal metaltarsal artery is best dissected and exposed in the retrograde direction. The toe must obtain good blood perfusion before its transplantation and close postoperative monitor.
The clinical experiences in the appieation of umbilical-thoracic skin flap in the coverage of the defect of the forearm in 9 cases were reported. The flap was supplied by the branches of inferior epigastric artery.The biggest flap was 8.5×28cm,the smallest one was 7× 16cm.All flaps surviVed.The results were satisfactory. The advantages of the flap were:(1)potients felt comfortable when the upper extremity was immobilized at the side of the they;(2)the size of skin taken from the do...
Objective To study the method and effect of transferring the pedicled second metatarsal base for repairing bone defect of lateral malleolus. Methods Thirty lower limb specimens were anatomized to observe the morphology, structure and blood supply of the second metatarsal bone . Then transferring of thepedicled second metatarsal base was designed and used in 6 patients clinically.All cases were male, aged from 24 to 48 years old, and the area of bone defect was 3-4 cm. Results Followed up for 3-11 months, all patients healed primarily both in donor and recipient sites. There were excellent results in 4 cases and good results in 2 cases . The morphology and function of the malleoli were satisfactory. Conclusion Transferring of the pedicled second metatarsal base for repairing bone defect of lateral malleolus is an effective and reliable operative method.
Objective To evaluate the clinical effect of end-to-end neurorrhaphy following rapid expansion of the nerve in repairing facial nerve defect. Methods From August 2000 to February 2005, 9 patients suffering from facial nerve defect were treated by the surgical method. The defect was caused by traffic injury(4 cases) , by cutting injury (2 cases) and falling wound(1 case). Seven cases showed prominent facial paralysis. The other 2 cases were invaded by parotid carcinoma, without remarkable paralysis. One case had unibranch defect, and the other 8 cases had multibranch defect. The nerve gap ranged from 1.5cm to 3.0 cm. After both the proximal and the distal segment had been dissected,the nerve was elongated by the expander designed and manufactured. The expansionwas done at a speed of 2.0 cm/30 min, and it lasted until the end-to-end neurorrhaphy can be done easily. The treatment result was evaluated according to Baker’s classification and HouseBrackmann’s grading system. Results Nine patients were followed up 618 months. In 5 cases achieving good result, both dynamic look and static look of face were symmetric, the EMG peak value of mimetic muscle was 82%95% of normal side. In 3 cases achieving fair result, thedynamic look and static look of face were basically symmetric, and the EMG peak value of mimetic muscle was 60%90% of normal side. In 1 case achieving poor result, the function of mimetic muscle was improved slightly, and the EMG peak value of mimetic muscle was 55% of normal side. Conclusion The satisfactory resultcan be obtained by endtoend neurorrhaphy following rapid expansion of the nerve in condition that nerve defect is less than 3.0 cm.
Objective To evaluate the results of chest wallreconstruction (CWR) in patients who underwent chest wall tumor resection accompanying huge chest wall defect. Methods From Jan. 1998 to Mar. 2003, 31 patients underwent CWR. Among them, 20 were male and 11 female. The age ranged from 8 to 72 years.The indications for resection were primary chest wall tumor in 21 patients, lung cancer with invasion of chest wall 6, recurrence of breast cancer 2, radiationnecrosis 1 and skin cancer 1. The number of rib resected was 2~7 ribs (3.6 in average). The defect was 20~220 cm2 (97.1 cm2 in average). Concomitant resectionwas done in 13 patients, including lobectomy or wedge resection of lung 10, partial resection of diaphragm 2, and partial sternectomy 1. Seven patients underwent soft tissue reconstruction alone(latissimus dorsi+greater omentum, latissimusdorsi myocutaneous flap, latissimus dorsi muscle flap), 5 patients bony reconstruction alone(Prolen web), and simultaneous BR and STR were performed in 19 patients(latissimus dorsi, pectorails major, latissimus dorsi+fascia lata, and Prolene web). Results Three patients (9.7%) developed postoperative complications. Postoperative survival period was 6~57 months with a median of 22 months. Conclusion A favorable clinical outcome can be achieved by CWR for the patients with hugechest wall defects that result from resection of chest wall tumors.
OBJECTIVE To investigate the feasibility of repairing the whole layer defects of tibial plateau by implanting tissue-engineering cartilage. METHODS: The chondrocytes of 2-week-old rabbits were cultured and transferred to the 3rd generation, and mixed with human placenta collagen-sponge. The whole layer defects of tibial plateau in adult rabbits were repaired by the tissue-engineering cartilage in the experimental group; the defects were left un-repaired in control group. The repair results of defects were observed after 4, 12 and 24 weeks. RESULTS: In experimental group, no obvious new cartilage formation was seen 4 weeks after operation; some new cartilage formation was found after 12 weeks. Histological observation showed that chondrocytes had irregular edge, honeycombing structure and that cartilage cavities formed around the chondrocytes. After 24 weeks, obvious new cartilage formation was found with smooth surface, and linked with the tissues around it, but the defect was not repaired completely; histological results showed that cartilage cavities formed and that cartilage matrix was stained positively for toluidine blue. In control group, the defect was not repaired. CONCLUSION: The tissue-engineering cartilage can repair the defects of the whole layer cartilage of tibial plateau in rabbits, it is feasible to repair the whole layer cartilage defects of tibial plateau by this method.
In order to improve the therapeutic effect of non-neural tissue in bridging the peripheral nerve defect and increase the blood supply of the implant, the silicone tube was chosen to bridge the gap, and the vessel bundle was inserted into the tube. The procedures were performed as following: resected the pseudoneuroma and enveloped the proximal and the distal ends in a silicone tube, and then sutured the epineurium and the tube wall with 7/0 stitch. In patients, eleven cases with fifteen nerves were treated, including seven median nerves, five ulnar nerves and three radial nerves. The lengths of the nerve defects were within 3 cm in 13 nerves and 3 cm-5 cm in 2 nerves. They were followed up from one to five years and the result was excellent (M4S4) in 8 nerves, good (M3S3) in 3 and poor (M1S1) in 2. It was discussed that the indication for the procedure should be included: the nerve defect could not be sutured directly, and the patient would not agree to use his own nerve for graft.
Objective To evaluate the application value of repairing the defects of the chest wall with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis. Methods From January 2002 to June 2005, five patients with defects in the chest wall underwent the prothesis with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis under general anesthesia. Focal cleaning was performed first; then, the skin flap was designed and taken (15 cm ×10 cm); and finally, the defects of the chest wall were repaired with the muscle flap of the musculus rectus abdominis. Results Of the 5patients, 4 had the flap healing by the first intention, and 1 had the delayed healing, with no complication. The skin flap had a good appearance, without edema orpigmentation. The X-ray examination showed that the shadow of the sternal sequestrum disappeared. There was no recurrence or complication during the follow-upfor 1-3 years (average, 18 mon). Conclusion The repairing of the defects in the chest wall with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis is a simple and effective surgical treatment for defects of the chest wall around the sternum, and this kind of treatment is worth applying extensively in clinical practice.
Objective To evaluate the effect of WO-1 on repair of the bone defect in the New Zealand rabbit radius by an oral or local administration. Methods Bone defects were surgically created in the bilateral radii of 36 Zealand rabbits (1.6-2.0 kg), which were randomly divided into3 groups. In Group A, the defective areas were given WO-1 0.1 ml (50 mg/ml) by the local injections; in Group B, the rabbits were given WO-1 5 mg each day by the oral administration. Group C was used as a control group. Among each of the 3 groups, 4 rabbits were randomly selected and were sacrificed at 20, 30 and 60 days after operation, respectively. Then, the serological, X-ray and histological examinations were performed. Results The serum alkaline phosphatase and bone glaprotein levels were significantly higher at 20 and 30 days after operation in Groups A and B than in Group C, but significantly lower at 60 days after operation in Groups A and B than in Group C（Plt;0.01）. The X-ray and histological examinations at 20, 30 and 60 days after operation revealed that the callus formation and remodeling were earlier in Groups A and B thanin Group C, and the remodeling was earlier and better in Group A than in Group B. Conclusion WO-1 can promote the repair of the radial defect in a rabbit; however, further studies on the doseeffect relationship, administration time, and administration route are still needed.
Our clinical experiences in reconstruction of the defects from excision of benign tumors with expanded skin flap were reported. Since 1987 we have applied this method 23 cases with satisfactory results. When we decided to use this technique, the expander was placed in a pocket adjacent to a benign tumor planned to be excised. Once the skin flap was expanded fully, the tissue expanders were removed. After excision of the benign tumor, the defect was than be covered with the expanded skin flap. The problems related to treatment were discussed in detail.
