Four cases of defects of soft palate followingcomplete resection of soft palate because ofmalignant tumors had been successfullyreconstructed in which 3 patients wereperformed reconstructed with forehead flap andone patient with free forearm flap . All the flapewere survived. The appearance of the soft palateand function of swallowing were recoveredsatisfactorily from reconstruction. The operativetechnique of the reeonstruction of soft palate wasintroduced,and the points of attention ...
OBJECTIVE: To investigate the clinical effects of the microsurgical treatment for the skin-degloving injury of the whole hand or foot. METHODS: From March 1984 to October 2001, we treated 6 cases of skin-degloving injury of the whole hand and foot. In 2 cases of skin-degloving hands, one was treated with free great omentum transplantation plus skin graft, the other with pedical abdominal S-shaped skin flap as well as mid-thick skin graft. In 4 cases of skin-degloving injury of the foot, 2 cases was repaired with free latissimus dosi musculocutaneous flap, 1 case with distall-based lateral skin flap of the leg and 1 case with free tensor fasciae latae muscle flap. The flap size ranged from 7 cm x 9 cm to 22 cm x 15 cm. One case was operated on the emergency stage, the other 5 cases on the delayed stage. The delayed time ranged from 2 to 14 days with an average of 6.6 days. RESULTS: All the flaps survived. After 1-2 year follow-up, the appearance and function of the hand and the foot were good. CONCLUSION: Microsurgery technique in repairing skin-degloving injury of the whole hand and foot can achieve good results. The keys to success are thorough debridement of the recipient area, appropriate selection of the donor site, good vascular anastomosis and active postoperative rehabilitation.
OBJECTIVE: To investigate the effect of subcutaneous tissue trimming on the survival skin area of avulsion skin flap. METHODS: Degloving injury was created in bilateral hind limbs of 7 pigs with avulsion injury machine, 4 cm x 10 cm avulsion skin flaps were elevated in degloving areas. Skin flaps in one side were replanted as control without any treatment. Subcutaneous tissue in the skin flaps of another side was partially excised and replanted by trimmed skin flaps. Survival skin flaps was calculated with computer at 7 days after operation. RESULTS: In the control group, the survival skin area was (40.41 +/- 9.23)%, while in the experimental group, the survival skin area was (60.90 +/- 15.26)%. There was significant difference between the two groups (P lt; 0.05). CONCLUSION: Trimming off subcutaneous tissue does improve the survival area of avulsion skin flap.
To compare the effect of trehalose with that of different traditional cryoprotectants on human skin and to detect the new protection mechanism of trehalose in hypothermia. Methods The skins to be cryopreserved were first treated with DMSO/Propyleneglycol (D/P group), trehalose/DMSO (T/D group), DMSO/ serumfree keratinocyte medium(D/K group), DMEM (DMEM group), respectively, so as to be compared with fresh skin (control grouop). Then the histological structure of skin of different groups was observed and analyzed by pathological technology (SP immunohistochemistry, DAB staining). Furthermore, the influence of trehalose on α-actinin at gene level with RT-PCR was investigated. The viabil ity of skin in 5 respective groups was evaluated by using succinate dehydrogenase (SDH). The experiments were carried out 14 days after cryopreservation. Results The results of immunohistochemistry showed that A values of control group, T/D group, D/P group, D/K group and DMEM group were 27.50 ± 7.92, 18.40 ± 5.81, 13.10 ± 5.11, 11.50 ± 4.54 and 5.30 ± 2.14, respectively. There was no significant difference between control group and T/D group (P gt; 0.05), but control group was significantly different from the other groups (P lt; 0.05). The results of PCR studies showed that A values of control group, T/D group, D/P group, D/K group and DMEM group were 0.816 ± 0.134, 0.723 ± 0.245, 0.564 ± 0.265, 0.245 ± 0.071 and 0.148 ± 0.048, respectively. Control group was not significantly different from T/D group and D/P group (P gt; 0.05), but was significantly different from D/K group and DMEM group (P lt; 0.05). The results of SDH showed that A valuse of control group, T/D group, D/P group, D/K group and DMEM group were 18.2 ± 3.7, 12.3 ± 3.6, 10.2 ± 2.4, 7.3 ± 2.1 and 5.7 ± 1.5, respectively. There was no significant difference between control group and T/D group (P gt; 0.05), while control group was significantly different from the other groups (P lt; 0.05). Conclusion The results suggest that cryopreservation protocol-trehalose/DMSO is better than the traditional cryoprotectant for ryopreservation on α-actinin of human skin.
OBJECTIVE In order to increase the survival area of pedicled fasciocutaneous flap, a multiple pedicled blocking randomized fasciocutaneous flap was designed. METHODS From January 1991 to September 1998, this technique was used to repair 33 cases, including 27 males and 6 females and the ages ranged from 6 to 58 years. All of the patients were suffered from traffic accidents. In these cases, 22 cases had skin defects of legs and feet with bone, nerve and tendon exposed, 5 cases had osteomyelitis as well as internal fixaters exposed and the other 6 had deformity from scar. The size of the flap was 25.0 cm x 13.0 cm x 2.4 cm at its maximum and 6.0 cm x 3.5 cm x 1.5 cm at its minimum. Based on the traditional blocking flap, according to the severity of the wound and conditions of the neighboring tissues, a flap having 2 to 4 orthogonal pedicles with a width of 1.5 to 3.0 cm was designed. The medical-graded stainless steel sheet was implanted below the deep fascia, and after blocking for 3 to 6 days, the side pedicles were divided. 6 to 14 days later, one of the two remaining pedicles was divided and was transferred to repair the defect. RESULTS 31 cases were followed up for 6 months to 5 years without any trouble of the joints. The flap had a good external appearance and was high pressure-resistant. CONCLUSION The multiple pedicled blocking randomized fasciocutaneous flap increased the size of the flap and the length to width ratio. It had the following advantages: manage at will, high resistance to infection and a large survival area of flap.
OBJECTIVE The repair of soft tissue defect of heel by traditional operation did not restore the sensation of the heel. METHODS In order to solve this problem, the saphenous neurovascular skin flap reinnervated by end-to-side neuro-anastomosis was designed and 3 male patients with soft tissue defects of the heel were so treated. Grossgraft of saphenous neurovascular skin flap was employed for repairing the soft tissue defects of heel and the pedicle was divided at 21 days after operation. The end-to-side neuro-anastomosis was used to reinnervate not only the skim flap, but also the skin area of the medial malleolus, medial aspect of the foot and the big toe of the donor limb. RESULTS After follow-up of 6-12 months, the walking and weight bearing functions of the affected limbs were good, the contour of the grafted area was satisfactory, and the recovery of sensation of the skin flap, the medial malleolus, the medial aspect of the foot and the big toe was observed. CONCLUSION 1. Crossgraft of the saphenous skin flap was an effective method to repair the soft tissue defect of the heel; 2. End-to-side neuro-anastomosis could restore the sensation of the skin flap.
OBJECTIVE: To explore the methods of treatment for old achilles tendon rupture merging with skin defect. METHODS: By following up retrospectively 10 patients from February 1995 to December 2001, we analyzed the operative methods, the points for attention and the results. Gastrocnemius musculocutaneous flaps were used in 3 cases, foot lateral skin flaps in 4 cases, superior medial malleolus skin flaps in 2 cases, and sural neural skin flap in 1 case. The Achilles tendon was sutured directly in 8 patients, with Lindholm’s technique in 2 patients. RESULTS: All flaps survived and the wound healed well in 8 cases and reruptured in 2 cases. According to Yin Qing-shui’s criteria to test the efficacy, the results were excellent in 5 patients, good in 4 and poor in 1. CONCLUSION: Repairing the old Achilles tendon rupture merging with skin defect by use of microsurgery has good results and plays an important role in reducing joint contracture and stiffness, and in saving the ability to push forward and flex.
Objective To improve the efficiency of skin soft tissueexpansion with the overlapping tissue expansion techniques. Methods From June 2003 to March 2005, 5 cases of skin soft tissue defects were treated with the overlapping tissue expansion techniquetwo overlapped expanders in one soft tissue pocket, which was different from the traditional technique——one expander in one soft tissue pocket. Five patients included 3 males and 2 females, aging from 11 to 28 years. The defect was caused by scar of forearm in 2 cases, by melanotic nevus in 1 caseand by cicatricial baldness in 2 cases. The disease course was 1.5 to 24 years. Thedefect size ranged from 12 cm×5 cm to 13 cm×12 cm. Results Skin expansion process was satisfactory and skin defect was completely repaired with the expanded skin tissue in one operation in 5 cases. After operation, the wound of donor-recipient site healed by first intention. All patients were followed up from 3 to 15months, no contracture, pigmentation and scar occurred at the expanded skin area. The long-term appearances were satisfactory. Conclusion Compare with the traditional tissue expansion techniques, the new overlapping tissue expansion techniques can apparently improve the efficiency of skin soft tissue expansion. Itis suitable for the patients whose expandable skin is limited or no more skin tissue can be dissected near the skin defect and who need more expandable skin torepair skin defect.
Objective To explore the mechanism of full-thickness burn wound healing with autoskin grafting in fault hypodermis wound of granulation excision and to evaluate its effect.Methods By the techniques of clinical observation, histopathology, immunohistochemistry,TEM and FCM,we observed changes of the activity andstructure of grafted skin and the granulation tissue,collagnous fiber,microvessels,the ultramicrostructure of fibroblasts and the expression of basic fibroblast growth factor(bFGF) in the base of autoskin grafting in fault hypodermis wound in burned adult minipigs(Group A), and compared with traditional method of autoskingrafting on the basilar fibrous tissue wound of scraped partly granulation being(Group B) and control group (Group C, without treatment except de-fur).Results The grafted skin survived after 3 days of operation, and it had less injury and higher proliferative index(PI) in group A than in group B. The hyperplasiaof granulation tissue and vascular endothelial and the expression of bFGF were more evident in group A. After 5 days, the proliferation of endothelial cells and granulation and the protein synthesis of fibroblasts were more active in groupA, and at this moment, fresh collagen appeared and proliferated more actively in group B. After 7-14 days, epidermic structure and dermic microvascular density became normal gradually, the granulation on grafting base matured and transformed into fibrous connective tissue in group A. The same change deferred about 2 days in group B. After 21 days, the above pathologic change in group A was less than that in group B. After 3060 days of operation, Group A achieved much less contraction and transfiguration than Group B, and the grafted skin was tender and movable. Conclusion Autoskin grafting in fault hypodermis wound of granulation excision has a better effect than traditional operation.
Objective The amniotic carrier complex membrane, which contains bFGF and vitamin C (VitC) and is loaded with BMSCs, is planted into the deeply-partial wounds of rabbits. To explore its influence on the epidermis renascence and regenerating speed in the process of the dermis restore. Methods BMSCs were isolated from the marrows of 24 healthy3-month-old New Zealand rabbits, male or female, weighing 1.0-1.5 kg. The BMSCs were cultured in vitro and purified, and then amniotic carrier complex membrane was prepared, whose size was 4.52 cm2. Three deep-partial wounds, with the area of about 3.14 cm2, were produced on the back of each rabbit. All the wounds were randomly divided into 3 groups: group A, group B and group C. Group A was the experimental group in which the amniotic carrier complex membrane was planted, including 1 ml BMSCs, 10 mL bFGF (0.2 mg/L) and 10 mL VitC (0.02 g/L). In group B, the amniotic carrier complex membrane was planted, including only 1 mL BMSCs. In group C, the amniotic carrier complex membrane alone was planted. After the operation, general observation was conducted. At postoperative 7, 14 and 21 days, respectively, the observation by HE, Masson, Van Giesonr staining and immunohistochemical staining of collagen type I was performed. The ink perfusion method was performed to evaluate the velocity and the qual ity of the wound heal ing after the transplantation. Results All the wounds obtained good heal ing. At 14 days after the operation, the ratio of wound heal ing was 60%, 41% and 23% in groups A, B and C, respectively. At 21 days after the operation, the the ratio of wound heal ing was 99%, 90% and 81% in groups A, B and C, respectively. There were significant differences between any two groups (P lt; 0.05). The depth of the newborn dermis, the number of the active collagen type I mascul ine cells and the number of the blood vessels in group A were better and more than in group B. And those in group B were better and more than in group C. At the exterior area of the newborn dermis, there was lots of regenerated epidermis from the peripheral normal skin, which in group A was better than in group B, and in group B was better than in group C. onclusion The amniotic carrier complex membrane transplanted to deep-partial wounds, which is appended withBMSCs, bFGF and VitC, can accelerate repair and reconstruction of the dermis. There has an optimal time of the renascence and regeneration of the epidermis in the process of dermis repair.
