OBJECTIVE To determine the role of endogenous carbon monoxide(CO) in oxidant-mediated organ injury following limb ischemia-reperfusion (I/R) in rats. METHODS: Sixty-four SD rats were divided into 4 groups: Sham group, Sham + zinc protoporphyrin (ZnPP, an inhibitor of heme oxygenase activity), 2-hour ischemia followed by 4-hour reperfusion (I/R) group and I/R + ZnPP group. Carboxyhemoglobin (COHb) level in the artery blood, malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in the lung, heart, liver and kidney were detected. The 24-hour survival rate of rats was studied. RESULTS: Compared with the sham group, the COHb level and MDA content significantly increased, while the SOD activity and the survival rate significantly decreased in I/R group (P lt; 0.05). Compared with the I/R group, MDA content significantly increased, while the SOD activity, the 24-hour survival rate and COHb level significantly decreased in I/R + ZnPP group (P lt; 0.05, respectively). CONCLUSION: Limb I/R could lead to the oxidant-mediated multiple organ injury accompanied by the increase of CO level which play an important role in the defense against I/R-induced remote multiple organ injury in rats.
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.
Objective To explore an effective method to repair penile-scrotal or perineal hypospadias in one stage with prepuce island flap.Methods Different prepuce island flaps were designed according to thedifferent pathological anatomy of the penile-scrotal or perineal hypospadias. The prepuce island flaps were thus translocated and sutured to form the urethra.Thirty-one cases of hypospadias (21 cases of peinil-scrotal type, 10 cases of perineal type) were repaired with prepuce island flap.The biggest length and the width of the prepuce island flapwere 7.5 cm and 1.5-1.8 cm respectively.Results All the cases resulted in a good contour of the penis and a normal anatomic position of urethral meatus without any redundancy or tortuosity.The urination was perfect and acceptable.Conclusion One stage repair of penilescrotal or perineal hypospadias with prepuce island flap can be considered as an acceptable effective surgical technique.
Various tissue flaps were used in the repair of 255 cases of the wounds from severe deep burns and cicatricial deformities. The types of flaps used included: 6 kinds of myocutaneous flaps in 54 cases, 10 kinds of axial cutaneous flaps in 50cases, 7 kinds of fasciocutaneous flaps in 44 cases, pedicled subcutaneous tissues flaps in 12 cases, pedicled thin skin flaps in 54 cases, subdermal vascular networks cutaneous flaps in 38 cases, and free skin flaps with arter ialization of vein flap, retrograd island cutaneous flap with great or small saphaneous vein, in each. The survival rate from the transplantation was 99.2 per cent, and the rate of primary healing was 94.5 per cent. According to the time interval between the injury and operation and the conditions of the wounds, the patients were divided into acute, infected and selective cases, and the rate of primary healing was 93.0 per cent, 91.6 per cent and 97.9 per cent, respectively. The selection of the types of flap to be used and the attentions to be taken dueing operation were discussed.
Objective To explore an improved method of surgical operation for reposition of the articular surface with Type Ⅲ Pilon fractures. Methods From January 1999 to December 2005, 20 patients (22 sides) with Type Ⅲ Pilon fractures were treated with the delayed open reduction and the internal fixation, which took the superior articular surface of the talus as a templet so as to reposition the lower articular surface of the tibia, strengthen the bone transplantation, fasten the internal fixation, and make an early functional exercise possible. Complete data were obtained from 16 of the patients with 18 sides (13 males,15 sides; 3 females, 3 sides; age, 14-48 years). The injury due to a fallingaccident was found in 12 patients (14 sides), and due to a traffic accident in 4patients (4 sides). Results The healing of the first intention was achieved in 14 sides, the delayed healing in 3 sides, and the infection in 1 side. The follow-up of all the 16 patients for 971 months (average, 22 months) including the X-ray examinations revealed that no screw for the internal fixation entering the articular cavity. According to the Teeny’s judging standards of radiology evaluating the result of the surgery for Pilon fractures, the anatomical reduction of the related articular surface was found in 77.8% of the sides (14/18) and thehealing of the first intention (stage Ⅰ) in 94.4% (17/18). According to the Mazur’s criteria, an excellent result was obtained in 5 sides, good in 7, fair in 5, and poor in 1. The excellent and good result was 66.7%. Conclusion Propermanagement of the injured soft tissues, prompt recovery of the tibial distant plateau height, and accurate reposition of the articular surface, enough transplant bone for the solid support, b internal fixation for the distant tibial anatomical structure, and early functional exercise are the key points to the successful operation.
Objective To design a combined flap of subscapular axis including vascularized lateral scapular,rib and latissimus dorsi to repair the large defect of tibia. Methods The patient was a 39-year-old man who got a posttraumatic 12 cm defect of tibiaafter primary debridement and external fixation because of open fracture 5 months ago. There was a 12 cm×6 cm scar involved the proximal medial segment of tibia.After resection of scar and fibular tissue over the bone defect floor, alatissimus dorsi myocutaneous flap 14 cm×5 cm pedicled with subscapular artery-thoracodorsal artery,a flap 12.5 cm on the outside of the scapular pedicled with thoracodorsal artery, and 6th rib flap 13 cm by serratus were prepared.The tibialis posterior and saphenous vein were used for astomosis. A proximalanatomic plate was applied to the fixation of tibia. Results Thecompound flap survived the operation. The follow-up period was 2 years. Bone union occurred 6 months after operation. Conclusion This combined flap is successful and can provide alternative to the resolution of large defect of tibia.
There is still a controversy on the treatment of the incomplete tear of tendons.Some authors insist to suture up, and some prefer not to suture. An animal experiment was performed for this purpose. One hundred twenty tendons of chicken feet were cut transverse and oblique cuts in equal number incompletely into 25%, 50% and 75%, respectively. Sixty tendons on the left feet were sutured up with external P.P. immobilization for 3 weeks while the other 60 tendons on the right feet were not sutured but with simple dressing only. The postoperative results assessed by various methods from functional observation and histological sectionsshowed that the suture group with external immobilization had a definitely superior result than that of the nonsuture group. The tendon cut over 50% was worse than those less than 50%. There was no much difference between whether the cut was transverse or oblique.
OBJECTIVE: To review the anatomy, etiology, therapy strategy of Achilles tendon injury and its related advances in recent years. METHODS: The related articles in recent years were extensively reviewed. RESULTS: There still were many arguments about the effect of corticosteroid on the treatment of tendon disease. Fluoqmnolone was found to be related with Achilles tendon injury. Acute rupture of Achilles tendon could be treated with open operation, percutaneous repair, or conservative therapy. For old rupture, many kinds of operations could be selected. CONCLUSION: The growth factors found in recent years provide us with new prospect for future treatment of Achilles tendon injury.
For the reconstruction of lacrimal passage in obligue facial cleft, three methods were performed in 4 cases. According to the difference in local pathology canaliculorhinestomy, transfer of vein or oral mucosa, or modified dacryocystorhinostomy was performed. The patients were followed for 6 to 12 months with satisfacting results.
From 1979 to 1994, reparative and recons tructive surgery were used to repair the war injuries of skins, bones, blood vessels and nerves of the limbs in 800 cases. A systematic clinical study was carried out. Many new operative methods were used and the results of treatment were good. Innovations and modifications were made in technique. In 120 cases of warin juries having soft tissues defects including skin and muscles, various tissue transplantations were used with the hope to accomplish onestaged repair of the defect and reconstruction of motor function of muscle. To those infections of bone and joint in war injuries, following early eradication of infected focus, transplantation of musculocutaneous flap or omental graft was immediately carried out with the aim to obtain primary healing of the wound. In the treatment of bone defects from war wounds with loss of skin and muscles, the vascularized skeletocutaneous graft was used. In the treatment of 150 cases of injury of peripheral nerve from forearms, the result of good to fair rated 68.8 percent for upper extremity and that for lower extremity, it was 62.2 percent. Following the early repair of 500 cases of injury of peripheral blood vessels, the patency rate of the blood vessel was 90 percent. The result following by pass vascular graft in the treatment of forearms injury of blood vessels even with very poor local condition was still very successful.
