OBJECTIVE: To provide a new reconstructive method to treat refractory ulcers on the sole of the forefoot. METHODS: The reversed medial plantar flap with the medial plantar pedal artery and vein as pedicle was used to treat the refractory ulcers on the sole of the forefoot in 5 cases. The size of the flap was 3.5-5.0 cm x 4.0-5.5 cm. The deformities were corrected at the same time and the flaps were protected after operation. RESULTS: All flaps survived without complications. There was no recurrence after 6-month following-up. The patients could walk. CONCLUSION: The distal ends of medial plantar pedal artery and vein have plenty anastomoses with dorsal pedal artery and deep plantar arch. The reversed medial plantar flap has reliable blood supply by these anastomoses. The reversed medial plantar flap should be a choice in treating refractory ulcers on the sole of the forefoot.
The soft-tissue-cutaneous flap adjacent to the abdominal incisional hernia was ultilized to repair huge hernia in 6 cases with success. Patients were followed up for 2y7 years without recurrence. The operative planning, the technique and the matters needing attention were introduced in details. The soft tissues and skin adjacent to hernia used for repair was easy to obtain and a simple technique. The adoption of this operation in hospitals at the grassroots level was feasible.
Objective To investigate the effect of microsurgical repair of refractory bone defects and nonunion in distal humers. Methods Twelve cases of bone defects and nonunion indistal humerus wererepaired with free vascularised fibular graft and fixed with the anatomical bone plate. Of the 12 cases, 8 had pseudarthrosis, and 4 had bone defects 3-5 cm. Fibular graft ranged from 5-15 cm, 8.5 cm in average. Results After a follow-up of 3-18 months, 8.5 months in average, all cases of free vascularised fibular graft healed within 38 months. The fibular graft thickenedas time passed. Normal recessive osseous elbow joint, improvement in the inflection and extension of elbow joint, and normal revolving of antebrachium were attained. The short of limbs were corrected. Satisfactory functions of supporting and fine operation were attained. Conclusion With the support of anatomical bone plate, the fibular graft can help the recovery of joint functionand repair bone defects and nonunion as to avoid joint replacement with prosthesis.
OBJECTIVE: To introduce the clinical application of long slender tubed flap constructed with "bridge" technique in the repair of nasal columella defect. METHODS: From March 1968 to August 1998, 18 cases with complicated nasal columella defects were repaired with long slender tubed flaps. Among the 18 tubed flaps, 13 cases were designed on the medial side of the upper arm and 5 cases on the longer cervical region paralleling the clavicle. The tubed flaps were 2.0 to 2.5 cm wide and 11 to 15 cm long. The length of the "bridge" was 3 to 7 cm. RESULTS: No flap necrosis or other complications occurred. Postoperative follow-up was 3 to 60 months. The reconstructed columellae showed satisfactory contour, good texture and color, and satisfactory resistance to injury. CONCLUSION: By using the "bridge" technique, tubed flap can be made long and slender enough to provide relatively abundant tissue with adequate circulation and delicate contour. Combined with strict case selection, long slender tubed flaps can bring excellent functional and cosmetic outcomes in the repair of nasal columella defects including those with partial defect of the nasal tip, ala, septum, or defect of adjacent soft tissue. However, this method is relatively time-consuming.
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 evaluate the phenomena of apoptosis and its relevant mechanism during ischemia-reperfusion period. Methods The published papers to explore the apoptotic phenomena and its mechanism in organs or tissues which experienced ischemia-reperfusion injury were reviewed. Results Apoptosis was common in ischemia-reperfusioned organ or tissue. The severity of apoptosis was influenced by many factors such as ischemia, hypoxia, oxygen free radials, intracellular free calcium ion overloading, various cytokines, et al; and also was regulated by bcl-2 family, caspase family and NF-κB，et al. Conclusion Apoptosis is a common phenomenum in ischemiareperfusioned organ or tissue which is affected and regulated by various factors.
Objective To construct a replicationdefective recombinant adinovirus including the target gene human bone morphogenetic protein 4(fragment hBMP-4). Methods The hBMP-4 gene fragment was cut down from pCS2(+)/hBMP-4, cloned into the eukaryotic expressive vector pcDNA 3.1(+), then subcloned into pShuttle-CMV and transformed into the competent E. coli BJ5183/p by electroporation. The resulting recombinant plasmid pAdE/hBMP-4 was transformed into the packaging of thecell lines HEK293 to produce the replication-defective recombinant adenovirusescontaining the hBMP-4 gene. These replication-defective recombinant adinoviruses were transfected into HEK293 and HeLa cells. Then, total RNA and total protein were detected by RT-PCR and the Western-blot assay. Results The pAdE/hBMP-4 was confirmed by the restrictional endonuclease digestion. In HEK293 and HeLa cells, the specific transcription of the hBMP-4 gene was confirmed by RT-PCR, and the expression of the hBMP-4 protein was confirmed by theWestern-blot assay. Conclusion The replication-defective recombinant adinovirus expression vector containing the hBMP-4 gene can be constructed and expressed successfully, which has laid a foundation for the further research on the genetherapy of hBMP-4.
Objective To investigate the expression of nuclear factor (NF)-κB and intercellular adhesion molecule (ICAM)-1 in rat′s retina injured by ischemia-reperfusion, and the effect of pyrrolidine dithiocarbamate (PDTC) on the expression of NF-κB and ICAM-1. Method The model of retinal ischemia-reperfusion was set up in 60 SD rats, which were divided into two groups with 30 rats in each: ischemia-reperfusion group and ischemia-reperfussion with injection of PDTC group. The left cephalic artery of each rat was ligated, and the right side was the control. Every group was subdivided into group 1 hour, 6, 12, 24, 48, and 72 hours after ischemia-reperfusion injury, and with 5 rats in each group. mRNA of NF-κB and ICAM-1 mRNA was measured by in situ hybridization (ISH) method in rat′s retina. Every rat underwent electroretinography (ERG) at the corresponding time before executed by neck breaking. Results In ischemia-reperfusion group, expression of NF-κB and ICAM-1 was detected at the 6th hour after ischemia-reperfusion, reached the highest level at the 24th hour, and weakened gradually later. In ischemia-reperfusion with injection of PDTC group, expression of NF-κB and ICAM-1 was detected at the 12th hour after ischemia-reperfusion, and reached the highest level at the 24th hour but lower than that in ischemia-reperfusion group. No expression of NF-κB and ICAM-1 was found in the control group. The relative recovery rate of ERG a and b wave amplitude in ischemia-reperfusion groups was lower than that in ischemia-reperfusion with injection of PDTC group at every stage(P＜0.01 ). The lowest relative recovery rate of ERG a and b wave amplitude in different stages in both of the 2 groups was at the 24th hour(P＜0.01). Conclusions NF-κB and ICAM-1 may play an important role in retinal ischemia-reperfusion injury, as the inhibitor of NF-κB, PDTC may relieve the retinal ischemia-reperfusion injury. (Chin J Ocul Fundus Dis，2004，20：175-178)
Objective To provide the anatomic basis for the posterior urethral repair via the perineal approach. Methods The anatomicconstructions andtheir relationships of the perineal approach from skin to the membranous and prostate apical urethra were observed and some related data were measured in 12 adult male specimens by microanatomy, and the procedures of urethral repair via the perineal approach were carried out in 3 fresh male specimens. Results All the blood vessels and nerves, which supplied the scrotum, the perineum, and bulbourethra, passed lateral-medially. The cavernous nerves coursed posterolaterally from the bottom to the apex of the prostate, pierced the urogenital diaphragm and passed laterally to themembranous urethra in a status of gridding, whose width was (12.11±2.32) mm.Conclusion The structures of the perineum and around the posterior urethra are complicated. The strategy for diminishing the damages to them is that all structures must be dissected strictly in the midline. Confining the dissections strictly to the range of 5 mm from the membranous urethra and resecting the apical prostatic tissues anterolaterally could avoid impairments of the cavernous nerves.
OBJECTIVE: To investigate the ability of repairing bone defect with the compound of coralline hydroxyapatite porous (CHAP), fibrin sealant(FS) and staphylococcus aureus injection (SAI), and the feasibility to use the compounds as bone substitute material. METHODS: The animal model of bone defect was made on the bilateral radius of 54 New Zealand white rabbits, which were randomly divided into the experimental group(the defect was repaired with CHAP-FS-SAI), control group(with autograft) and blank control group(the defect was left unrepaired) with 18 rabbits in each group. The ability of bone defect repair was evaluated by gross observation, histopathological study, X-ray and biomechanical analysis 2, 4, 8 and 12 weeks after repair. RESULTS: (1) In the 2nd week, tight fibro-connection could be found between the implant and fracture site and there were many fibroblasts and capillary proliferation with many chondrocytes around CHAP in the experimental group, while only a few callus formed, and chondrocytes, osteoblast and osteoclast existed in the control group. (2) In experimental group and control group, a large quantity of callus was found 4 and 8 weeks; ossification of chondrocytes with weave bone formation were found 4 weeks and many osteocytes and weave bones and laminar bones were found 8 weeks. (3) In the 12th week, the complete ossification of implant with well bone remodeling, a large number of mature osteocytes and laminar were found in experimental group and control group, and CHAP still existed in the experimental group; the defect area filled with fibro-scar tissue and only many fibroblasts could be seen in blank control group. (4) X-ray findings were the following: In experimental and control groups, callus formation could be seen 2 weeks postoperatively, more callus formed 4 weeks, the bone defect area disappeared and CHAP scattered in the callus 8 weeks; the fracture line disappeared and medullary cavity became united (in control group); and in the 12th week, the cortex became continuous, the medullary cavity became united, and remodeling completed, while bone defect was not still united in blank control group. The maximal torque and torsional stiffness in the experimental group is higher than those in the control group 2 weeks (P lt; 0.05), but there was no significant difference (P gt; 0.05) between the two groups 4, 8, 12 weeks after repair. CONCLUSION: The compound of CHAP-FS-SAI has good biological compatibility, and it can be used for one kind of bone substitute material to repair the bone defect.
