ObjectiveTo investigate the effectiveness of the free medial sural artery perforator flap for repairing anterior dorsal foot wound.
MethodsBetween January 2010 and April 2015, 16 patients with skin and soft tissue defects of the anterior foot dorsal side were treated. There were 12 males and 4 females with the average age of 35 years (mean, 16-58 years). The disease causes included burn in 5 cases, traffic accident injury in 8 cases, and crush injury in 3 cases. The time from injury to admission was 2-30 hours (mean, 6.5 hours). The wound area ranged from 4 cm×3 cm to 10 cm×7 cm; combined injury included defects of lateral collateral ligament and joint capsule in 3 cases, and bone exposure in 12 cases, and all had exposure of tendon. Wounds were repaired with the medial sural artery perforator flap in 13 cases, and with medial sural artery perforator composite tissue flap carrying of medial head of gastrocnemius muscle flap in 3 cases. The size of flaps ranged from 5 cm×4 cm to 11 cm×8 cm. The donor site was sutured directly or was repaired with skin grafting.
ResultsAll flaps survived well and wounds healed with stage I; skin grafts at donor site survived and the incision healed with stage I. All patients were followed up 6-36 months (mean, 11 months). The appearance of skin flap was satisfactory, without overstaffed; the joint of reconstructed ligament was stable, without secondary deformity. There was no obvious depression at the donor site, and no effect on the function.
ConclusionThe medial sural artery perforator flap has the advantages of relatively constant perforator anatomy, reliable blood supply, and carries the gastrocnemius muscle flap for repair of compound tissue defect. It is one of better ways to repair the anterior dorsal foot wound.
Objective To review the latest research progress of full-thickness tissue engineered skin (FTTES), to thoroughly understand its current state of research and appl ication so as to lay a sol id foundation for developing new type FTTES and improving the qual ity of skin substitutes. Methods Domestical and international l iterature concerning FTTES in recent years was extensively reviewed and comprehensively analyzed. Results Some progress of FTTES had made in seedcells, scaffold materials and construction, and some therapeutic efficacy had also been achieved in cl inical appl ication. ButFTTES grafting successful rate was lower, and it had no complete skin structure and had not reached the requirements of cl inicalappl ication. Conclusion FTTES is an ideal skin substitute and has great development prospects. However, in seed cells, scaffold materials, construction and appl ications of FTTES, further studied is still needed.
【Abstract】 Objective To investigate the effectiveness of the vacuum sealing drainage (VSD) technique with split middle thickness skin replantation for the treatment of severe skin closed internal degloving injury (CIDI). Methods Between July 2008 and April 2011, 16 patients with severe skin CIDI were treated. There were 11 males and 5 females, aged 17-56 years (mean, 28 years). Injury was caused by traffic accident in all cases. The time between injury and operation was 2-8 hours (mean, 5 hours). Peeling skin parts included the upper limb in 3 cases and the lower limb in 13 cases. The range of skin exfoliation was 5%-12% (mean, 7%) of the body surface area with different degree of skin contamination. After thorough debridement, exfoliative skin was made split middle thickness skin graft for in situ replantation, and then VSD was performed. Results After 7 days of VSD therapy, graft skin survived successfully in 14 cases; partial necrosis of graft skin occurred in 2 cases, and was cured after thorough debridement combined with antibiotics for 7 days. All patients were followed up 6-18 months (mean, 12 months). The appearance of the limb was satisfactory without obvious scar formation, and the blood supply and sensation were normal.The joint function was normal. Conclusion For patients with severe skin CIDI, VSD treatment combined with split middle thickness skin replantation can improve the local blood circulation of the limb, promote replantation skin survival, and shorten healing time of wound. The clinical effectiveness is satisfactory.
ObjectiveTo sum up the clinical characteristics,surgical management,and effectiveness of pressure sore of sinus type.
MethodsBetween January 2009 and April 2013,17 patients with 19 pressure sores of sinus type after traumatic paraplegia were treated,and the clinical data were analyzed retrospectively.There were 11 males and 6 females with an average age of 27.4 years (range,17-49 years).The median disease duration was 1.5 years (range,6 months to 7 years).Of 17 cases,there were 14 primary cases and 3 recurrent cases; 10 focuses of 8 cases were classified as simple sinus type,and 9 focuses of 9 cases as complex sinus type,which had a false synovial sheath complicated with one to four "second sinus".The pressure sore of sinus type majorly located at the ischial tuberosity.The size of pressure sore ranged from 1.5 cm×1.0 cm to 3.0 cm×2.0 cm,and the length of "second sinus" ranged from 8 to 32 cm with an average of 17 cm.After the false synovial sheath was totally excised,the wound was repaired by local sliding or rhombus flaps at the first or second stage in patients with simple sinus type pressure sore.On the basis of excising the false synovial sheath,the "second sinus" was totally removed in the patients with complex sinus type pressure sore.
ResultsWound dehiscence occurred in 1 case of simple sinus type pressure sore at 4 days,which was cured after it was sutured again.Wound infection occurred at 9,17,and 23 days respectively in 3 cases of complex sinus type pressure sore,which was cured after second debridement and necrosis tissues removal.The other wounds healed by first intention,and the flaps totally survived.All patients were followed up 6-12 months (mean,9.3 months).No recurrence was observed.
ConclusionAccording to the clinical characteristics,pressure sore of sinus type could be divided into simple sinus type and complex sinus type.The key of successful treatment is to thoroughly excise false synovial sheath and "second sinus".
Objective To investigate the method and the effectiveness of open pelvic fractures associated with perineal injury. Methods Between August 2000 and July 2010, 16 cases of open pelvic fractures associated with perineal injury weretreated. There were 12 males and 4 females with an average age of 41 years (range, 17-69 years). Injury was caused by traffic accidents in 9 cases, by falling from height in 6 cases, and by crushing in 1 case. The mean time between injury and admission was 8 minutes (range, 5-20 minutes). According to Tile classification, 2 cases were rated as type A, 6 as type B, and 8 as type C. The wound size ranged from 5 cm × 3 cm to 15 cm × 12 cm. The perineal injured location included intraperitoneal rectal injury in 2 cases and extraperitoneal anorectal injury in 14 cases. The average injury severity score (ISS) was 29 (range, 25-48). The main treatments included emergency resuscitation, colostomy, external fixation of fractures, repeated debridement with pulsatile irrigation followed by intravenous antibiotics, and vacuum seal ing drainage (VSD). Results In 5 deaths, 3 cases died of hemorrhagic shock and 2 cases died of multi ple system organ failure within 4 days of admission. The other 11 cases were followed up 6-46 months (mean, 14 months). The X-ray films showed that bone union was achieved after 2-4 months of operation. Infection in varying degree occurred at perineal wounds; second stage healing of wounds was achieved in 10 cases after debridement and VSD treatment, and wound healed in 1 case after gracil is muscle flap repair. No anal incontinence occurred in the patients having anorectal injury during follow-up. Conclusion For patients with perineal injury and open pelvic fractures, the following treatments should be carried out so as to obtain good effectiveness: early anti-shock, protection of important organ function, treatment of complications, late resistance to infection and stabil ity restoration of the pelvic ring, functional repair and reconstruction of rectum and anal canal and urinary tract.
Objective
To investigate the effectiveness of pedicled superior gluteal artery perforator bilateral quadrilobed flaps for repairing large sacrococcygeal pressure sores.
Methods
Between June 2003 and August 2011, 6 paraplegia patients with large sacrococcygeal pressure sores were repaired with the pedicled superior gluteal artery perforator bilateral quadrilobed flaps. There were 2 males and 4 females with an average age of 45.6 years (range, 37-62 years). The mean disease duration was 8.4 months (range, 3-26 months). According to National Pressure Ulcer Advisory Panel (NPUAP) standard, 6 cases rated as degree IV. The size of pressure sores ranged from 15 cm × 13 cm to 18 cm × 16 cm. The size of flaps ranged from 18 cm × 14 cm to 21 cm × 15 cm.
Results
After operation, all flaps survived successfully. The wounds healed by first intention in 5 cases; partial dehiscence of incision occurred in 1 case, which was cured after dressing change for 26 days. Six patients were followed up 6-24 months (mean, 12.5 months). The appearance and texture of the flaps were smooth and soft with good elasticity and no ulceration.
Conclusion
Pedicled superior gluteal artery perforator bilateral quadrilobed flaps can repair large sacrococcygeal pressure sores. The appearance of flaps is smooth and has good compression-resistance effect.
Objective To observe the effectiveness of skin graft combined with thorax wire fastening for repairing postoperative coloboma after resection of chest back giant nevus. Methods Between June 2007 and October 2010, 17 cases of chest back giant nevus were treated. There were 7 males and 10 females, aged from 3 years and 6 months to 15 years(mean, 8 years). The size of giant nevus was 20 cm × 12 cm to 60 cm × 50 cm. Two cases of them were ever treated by laser, while the others were never treated. The check before operation showed ulcer of the skin and effusion in 2 cases, hard skin in 3 cases, hair growth in 7 cases, and normal in 5 cases. Five cases had serious itch. After giant nevus was cut off, thorax wire was fastened to reduce the wound area, and then the intermediate spl it thickness skin graft of thigh was used to repair the wound. Comprehensive anti-scar treatment was given postoperatively. Results The wound size was (2 110.74 ± 725.69) cm2 after resection of giant nevus, and was (1 624.94 ± 560.57) cm2 after thorax wire fastening, showing significant difference (t=9.006, P=0.001). All the grafting skin survived; the incision and wound at donor site healed by first intention. The patients were followed up 6 months to 2 years (mean, 13 months). No scar prol iferation or contracture occurred. The skin color and elasticity were similar to the normal skin; the nipple, navel, and other local apparatus were not shifted after operation. Conclusion It can reduce donor site of skin and postoperative scar, and achieve satisfactory appearance to cover the wound by skin graft combined with thorax wire fastening after chest back giant nevus was cut off .
ObjectiveTo investigate the application of autologous keratinocyte suspension transplantation in skin reconstruction.
MethodsForty adult Sprague Dawley rats (weighing, 210-230 g) were randomly divided into 4 groups (n=10): high density keratinocyte suspension transplantation (1×106 cells/cm2) group (group A), middle density (1×105 cells/cm2) group (group B), low density (1×104 cells/cm2) group (group C), and control group (group D). Skin samples were harvested from the rats in groups A, B, C for the isolation of keratinocytes. The model of anti-contracture of full thickness skin wound was made in rats and autologous keratinocyte suspension was transplanted into the wound. The wound was covered by the allogeneic skin (allogeneic skin derived from Wistar rats). The survival of rats was observed after operation. The survival of allogeneic skin was observed at 7, 14, and 21 days after operation, and wound healing rate was calculated after allogeneic skin dropped off. Histological staining and immunohistochemical staining were carried out at 21 days after operation.
ResultsAll the rats survived to the end of the experiment. The allograft skins survived in all groups, dried and dropped off. The epithelium sheet could be seen in groups A and B at 21 days, a few very thin epithelium in group C, and no epithelization in group D. The wound healing rate of groups A (62.9%±9.6%) and B (64.2%±9.1%) were significantly higher than that of groups C (38.5%±5.7%) and D (22.7%±5.5%) (P<0.05), and significant difference was found between groups C and D (P<0.05), but there was no significant difference between groups A and B (P>0.05). The results of histological observation showed that squamous epithelial cells were observed in groups A, B, and C, but not in group D; obvious layers of epidermis were observed in groups A and B, thin epidermis and inflammatory cell infiltration in group C, and granulation tissue in group D. The immunohistochemistry staining showed that the expressions of collagen type IV and collagen type VII in groups A, B, and C; the percentage of collagen type IV and collagen type VII positive cells in groups A and B were significantly higher than that of group C (P<0.05), but there was no significant difference between groups A and B (P>0.05). The expressions of collagen type IV and collagen type VII in group D were negative.
ConclusionThe repair of full thickness skin wound with graft of autologous keratinocyte suspension can achieve reconstruction of the skin. The appropriate density of keratinocyte suspension for wound healing is 1×105 cells/cm2.
Objective To explore the therapeutic effect of recombinant human epidermal growth factor (rhEGF) for burn wounds of degree II in the elderly patients. Methods From February 2003 to October 2008, 80 patientes with burn wounds of degree II were treated and randomly divided into two groups (n=40). In treatment group, there were 24 males and 16 females with an average age of 70 years (60-86 years), including 20 cases of superficial II degree and 20 cases of deep II degree.Burn wounds were caused by flame in 23 cases, by hot l iquid in 16 cases, and by electricity in 1 case. The mean time from injury to hospital ization was (2.87 ± 2.57) hours. The wounds were treated with silver sulfadiazine (SD-Ag) and rhEGF. In control group, there were 18 males and 22 females with an average age of 69 years (61-83 years), including 19 cases of superficial II degree and 21 cases of deep II degree. Burn wounds were caused by flame in 23 cases, by hot l iquid in 14 cases, by electricity in 2 cases, and by chemistry in 1 case. The mean time from injury to hospital ization was (3.39 ± 3.33) hours. The wounds were treated with SD-Ag. The dressing was changed every day until wounds heal ing. There were no significant differences in general data between two groups (P gt; 0.05). Results Wound did not heal in 1 case (deep II degree) of treatment group and in 5 cases (deep II degree) of control group over 40 days and free skin graft was used to repair wound. One case (superficial II degree ) in control group gave up treatment. One case (deep II degree) died of pulmonary infection in treatment group. These cases were excluded and 72 cases were analysed. No other side reactions were observed in teatment group except for flash stabbing pain (4 cases) and pruritus (2 cases). Wound infection occurred in 5 cases of the control group and in 3 cases of the treatment group, and wound healed after symptomatic treatment. The heal ing time of burn wound was (14.30 ± 1.26) days (superficial II degree) and (26.11 ± 2.97) days (deep II degree) in the treatment group, was (16.22 ± 1.40) days (superficial II degree) and (29.13 ± 4.99) days (deep II degree) in control group, showing significant difference between two groups (P lt; 0.05). Conclusion Incombined treatment, rhEGF can promote the heal ing of burn wounds of degree II in the elderly patients.
ObjectiveTo investigate the feasibility of the free descending branch of lateral circumflex femoral artery perforator tissue flap (fascia flap plus skin flap) to repair large soft tissue defects of the extremities and its impact on the donor site.
MethodsBetween January 2013 and February 2015, 9 cases of large tissue defects of the extremities were repaired with the free descending branch of lateral circumflex femoral artery perforator tissue flap. There were 8 males and 1 female, aged from 13 to 56 years (median, 36 years). The causes included traffic accident injury in 6 cases and crushing injury by heavy object in 3 cases. Soft tissue defect located at the lower limbs in 7 cases and at the upper limbs in 2 cases, including 2 cases of simple tendon exposure, 2 cases of simple bone exposure, and 5 cases of tendon and bone exposure. After debridement, the soft tissue defect area ranged from 13 cm×7 cm to 20 cm×18 cm. The tissue flaps ranged from 14 cm×8 cm to 23 cm×19 cm. The donor site was directly sutured, scalp graft was used to cover the fascia flap.
ResultsAfter operation, partial necrosis of the skin grafting on the fascia flap occurred in 2 cases and healed after dressing change. Arterial crisis occurred in 1 case and the flap survived after anastomosis. The other tissue flaps survived and wounds healed by first intention. The skin grafting healed by first intention in 7 cases, by second intention in 2 cases. The patients were followed up 4-24 months (mean, 10 months). The appearance and function of the tissue flaps were satisfactory, only linear scar was observed at the donor site, which had less damage and no effect on walking.
ConclusionFree descending branch of lateral circumflex femoral artery perforator tissue flap can repair large soft tissue defect of the extremities. The donor site can be sutured directly, which reduces damage to donor site and is accord with the principle of plastic surgery.
