Objective To provide theoretical evidence for clinical application of the epidermal stem cells after an investigation on changes of the epidermal stem cells during the survival process after the fullthickness skin autograft. Methods On the backs of 42 Wistar rats, orthotopic transplantation models (1.5 cm×1.5 cm) of the fullthickness skin autograft were made. According to the time of the specimen taking, at 1, 3, 5, 7, 14, 21 and 30 days after operation, the rats were randomly divided in 7 groups (Groups 1-7). Specimens taken in each group before operation were used as controls. At each time point, the gross observation was made on the transplanted skin flaps, from which the skin tissues were harvested at each time point before and after operation. The routine pathological and the immunohistochemical examinations were performed on the specimens, which were stained by HE and were observed for immunohistochemical changes and the changes in the cells positive for integrinβ-1 and p63. Results All the fullthickness skin autografts survived 3 days after operation except the skin autograft in 1 rat in both Group 5 and Group 6, which was infected around the transplanted skin flap. In Groups 1-4, cell edema, inflammatory cell infiltration, and increased fibrocytes were observed. In Groups 5-7, the maturity degree of the epithelial cells became higher and higher, and the fibrocyte proportion was lowered. In each group the cell positivity rate for integrin β1 was lower than the cell positivity rate for p63. The positive cells were arranged in disorder, distributed into the layers of the epidermis and gradually concentrated in the basal layer of the epidermis and the bulge of the folliculus pili. The positive cells were also found in the other layers of the epidermis.The positive cells were gradually decreased in number, and reached the lowest level in Group 2. There was a significant difference in the above variables in Groups 1,2,3,5,6 and 7 between before and after operations (P＜0.05). Conclusion During the survival process of the fullthickness skin autograft, the proportion of theepidermal stem cells is gradually decreased at first; Then, the proportion isgradually increased, even beyond the normal level; finally, the proportion is decreased again. The distribution of the epidermal stem cells appear in disorder, almost distributed in the layers of the epidermis; finally, the almost normal distribution can be found.
The dynamic changeS of density of epidermal melanocytes in the full-thickness autografts of skinon guinea pigs were investigated by means of histochamical and autoradiographic techniques at variousjntervals during 3 months peried potoperatively,It was found that the increase of epidermalmelaneeytes was accompanied by hyperpigmentation of the skin grafts. Meanwhils,the amount of 3H-TdR taken by the melanocytes was increased. The results showed that the melanocytes poitive to Dopabecame...
To understand the reason of hyperpigmentation following full-thickness skin autograft, 54 guinea pigs were selected as skin autograft models. The changes of density of epidermal keratinocyte (KC) and the amount and distribution of melanin in the epidermal KC were observed by histological, histochemical and autoradiographic techniques. The results showed: (1) The histological changes of KC were in fact a wound-repair process; (2) The increased melanin in KC coordinated with "multi-overlapping screen" effect, a result of multiple layers of "supranuclear cap", was the direct cause of hyperpigmentation of the graft and (3) The hydrolytic disturbance of melanin in KC and the longer life span of the KC were probably the important reasons for the increase of melanin in the epidermis.
Objective To make a comparison for the change of maximum tensile intensity and stiffness of a whole implant that is placed into bone tunnel with various lengths tendon, by using beagle dog’s autogenous flexor tendons to reconstruct anterior cruciate l igament (ACL). Methods Sixty male beagle dogs were included in the experiment (weighting 13-16 kg). Three dogs were used for intact flexor tendon of both knees (normal control group), 3 dogs for the intact ACL andfemur-graft-tibia complex (auto control group) and 54 dogs (108 knees) for models of reconstructed ACL (6 experimentalgroups according to different lengths of tendon: 5, 9, 13, 17, 21 and 25 mm in the bone tunnel). The tensile intensity and stiffness were measured after 45, 90 and 180 days separately after operation. Results In the normal control group, the maximum tensile intensity of the intact flexor tendon was (564.15 ± 36.18) N, the stiffness was (59.89 ± 4.28) N/ mm. In the auto control group, the maximum tensile intensity of the intact ACL was (684.75 ± 48.10) N, the stiffness was (74.34 ± 6.99) N/ mm, all ruptured through the intra-articular portion of the graft. The maximum tensile intensity of femur-graft-tibia complex in the auto control group was (301.92 ± 15.04) N, the stiffness was (31.35 ± 1.97) N/mm. After 45 days of operation, all failure occurred at the tibial or femoral insertion site. After 90 days of operation, 24 of the breakpoints were scattered in tendon-bone junction, 12 (3 in 17 mm group, 5 in 21 mm group, 4 in 25 mm group) ruptured through the intra-articular portion. After 180 days of the operation, all breakpoints were distributed inside joint of the implant. The maximum tensile intensity and the stiffness were ber in 17, 21 and 25 mm groups than in 5, 9 and 13 mm groups after operation (P lt; 0.05). Conclusion Tendon with 17 mm length, which will be implanted into bone tunnel, is an appl icable index, in reconstruction of ACL by autogenous tendons.
OBJECTIVE: To investigate the effective method to treat cicatricial baldness. METHODS: From 1993 to 1998, 21 cases with multi-region or great-dimensional cicatricial baldness were treated with scalp expanding and hair autografting. Among them, there were 17 males and 4 females, aged from 14 to 49 years old. The operation was divided into two stages, stage one meaned to embed the expander under the scalp and stage two meaned to sow the autogenous hair. RESULTS: All cases, no matter what the position and area, were repaired successfully. The biggest dimension of repaired baldness was 340 cm2, one expander exposed and one failed in expanding after operation and be corrected immediately. The normal hair direction changed in two cases. CONCLUSION: Combined use of scalp expanding and hair autografting is an effective method to treat multi-region or great dimensional cicarticial baldness.
Objective To investigate the feasibil ity of core fat transfer by comparing with traditional Coleman technique. Methods The fat was obtained from 11 patients scheduled for fat transfer by 2 ways: Coleman’s method and core fat graft. The latter was harvested by a modified 1 mL syringe. Then 48 nude mice at the age of 3-4 weeks, male or female, weighing 8.6-12.2 g, were divided into 2 groups randomly (n=24). The dorsal subcutaneous space was recipient site. In the experimental group, 0.5 mL core fat was transplanted into dorsal subcutaneous space; in the control group, 0.5 mL fatobtained by Coleman’s method was transplanted into the same site. The appearance of the back was observed after operation; fat specimens were procured at 1, 2, 4, and 8 weeks after operation for the gross, histological, and immunohistochemical observations; and the residual weight of free fat-graft was calculated by the difference between pre- and post-operative mouse weights. The glucose transportation quantities and cell viabil ity were measured immediately after obtaining fat. Facial augmentation procedure was performed with core fat graft in 11 patients with local depressed deformity between May 2010 and October 2011. Results The uplift of the back was maintained in the experimental group, but the back of mice became flat in the control group at 2 weeks postoperatively. There was no significant difference in the weight of fat-graft between 2 groups (P gt; 0.05). The residual weight of fat-graft in the experimental group was significantly higher than that in the control group at the other time (P lt; 0.05, except for 2nd week postoperatively). The histological observation showed good cell morphology and well-distributed vessels in the experimental group, but obvious destruction of the cells and most vessels at the edge of fatgraft in the control group. The normal fat cells in the experimental group were significantly more than those in the control group after operation (P lt; 0.05), except for 2nd week). The capillaries in the experimental group were fewer than those in the control group, showing significant differences at 1 week and 2 weeks (P lt; 0.05) and no significant difference at 4 and 8 weeks (P gt; 0.05). The glucose transportation quantities in the experimental group [(1.462 ± 0.080) mmol/L] was significantly higher than that in the control group [(1.153 ± 0.199) mmol/L] (t=3.317, P=0.021). The higher cell viabil ity was also proved in the experimental group. Eleven patients were followed up 2-9 months, and no obvious atrophy or collapses was observed at reci pient site. Conclusion Compared with Coleman technique, core fat graft can keep the structure and viabil ity of harvested fat tissue by avoiding certain damages of fat cell. Therefore, the earl ier anastomoses between the host and core graft fat can reduce tissue loss and improve the fat survival. So it is recommended for enblock fat graft.
There were several methods, such as free single and folded fibulae autograft, composed tissue autograft, however, it is still very difficult to repair long segment bone defect. In December 1995, we used free juxtaposed bilateral fibulae autograft to repair an 8 cm of femoral bone defect in a 4 years old child in success. The key procedure is to strip a portion of the neighboring periosteal sleeve of juxtaposed fibulae to make bare of the opposite sides of the bone shafts, suture the opposite periosteal sleeves, keep the nutrient arteries, and reconstruct the blood circulation of both fibular by anastomosis of the distal ends of one fibular artery and vein to the proximal ends of the other fibular artery and vein, and anastomosis of the proximal ends of the fibular artery and vein to lateral circumflex artery and vein. After 22 months follow up, the two shafts of juxtaposed fibulae fused into one new bone shaft. The diameter of the new bone shaft was nearly the same as the diameter of the femur. There was only one medullary cavity, and it connected to the medullary cavity of femur. This method also cold be used to repair other long segment bone defect.
ObjectiveTo assess the effectiveness of lateral ligament reconstruction with autogenous partial peroneus longus tendon for chronic lateral ankle instability.MethodsBetween September 2014 and November 2018, 32 patients (32 sides) with chronic lateral ankle instability were treated with lateral ankle ligament reconstruction by using autogenous anterior half of the peroneus longus tendon. There were 25 males and 7 females, with an average age of 28.5 years (range, 20-51 years). The disease duration was 6-41 months (mean, 8.9 months). The preoperative Karlsson-Peterson ankle score was 53.7±9.7. The talar tilt angle was (14.9±3.7)°, and the anterior talar translation was (8.2±2.8) mm. Six patients combined with osteochondral lesion of talus and 4 patients combined with bony impingement.ResultsAll incisions healed by first intention postoperatively. All patients were followed up 12-53 months (mean, 22.7 months). At last follow-up, the Karlsson-Peterson ankle score was 85.2±9.6; the talar tilt angle was (4.3±1.4)°; the anterior talar translation was (3.5±1.1) mm. There were significant differences in all indexes between pre- and post-operation (P<0.05). Seventeen patients were very satisfied with the results, 10 patients were satisfied, 4 patients were normal, and 1 patient was unsatisfied. After operation, the ankle sprain occurred in 7 cases, the tenderness around the compression screws at calcaneus in 5 cases, the anterolateral pain of ankle joint over 6 months in 4 cases. No patient had discomfort around the reciepient sites. At last follow-up, the ultrasonography examination showed that there was no significant difference in the density and diameter between bilateral peroneus longus tendons in 12 cases.ConclusionFor chronic lateral ankle instability, the lateral ankle ligament reconstruction with the autogenous partial peroneus longus tendon is a safe and effective surgical option.
Objective To investigate the clinical outcomes of autologous platelet rich plasma (PRP) for anterior cruciate ligament (ACL) reconstruction. Methods Between August 2014 and August 2016, 42 patients with ACL ruptures who underwent arthroscopic ACL reconstruction were randomly divided into 2 groups: 21 patients received graft soaked with PRP (trial group) and 21 patients received routine graft in ACL reconstruction (control group). Because 6 patients failed to be followed up, 17 patients of trial group and 19 of control group were enrolled in the study. There was no significant difference in gender, age, body mass index, side, injury reason, disease duration, Kellgren-Lawrence grade, and preoperative visual analogue scale (VAS), Lysholm score, and International Knee Documentation Committee (IKDC) activity scores between 2 groups (P>0.05). VAS score, Lysholm score, and IKDC activity scores were used to evaluate pain and function at 3 and 12 months postoperatively. Further, second arthroscopy and MRI examination were performed at 12 months postoperatively. Results The patients in both groups were followed up 3 to 12 months with an average of 9.83 months. The VAS score, Lysholm score, and IKDC activity scores were significantly improved at 3 and 12 months after operation in 2 groups (P<0.05), and the scores of trial group were significantly better than those of control group at 3 months (P<0.05), but no significant difference was found between 2 groups at 12 months (P>0.05). No complications of effusion, infection, and allergy were observed in 2 groups during follow-up. MRI showed good position of ACL grafts and good signal quality of the graft in the majority of the cases. However, mixed hyperintense and presence of synovial fluid at the femoral bone-tendon graft interface were found in 3 patients of trial group and 4 patients of control group, indicating poor remodeling ligamentation. MRI score was 3.53±1.13 in trial group and was 3.21±0.92 in control group, showing no significant difference (t=0.936,P=0.356). The second arthroscopy examination showed ligament remodeling score was higher in trial group than control group (t=3.248,P=0.014), but no significant difference was found in synovial coverage score and the incidence of cartilage repair (t=2.190,P=0.064;χ2=0.090,P=0.764). Conclusion PRP application in allograft ACL reconstruction can improve knee function and relieve pain after operation, which may also accelerate graft remodeling.
Objective To investigate the feasibility and effect of stentedpulmonary autograft replacement and find out the best way to treat mitral valve diseases. Methods From August 2006 to October 2007, 20 male sheep at the age of about 1 year old underwent mitral valves replacement operation in Anzhen Hospital. Weight of these sheep was 50.0±6.0 kg. They were randomly divided into two groups. Ten sheep in the experimental group underwent RossⅡsurgery in which we first sutured pulmonary valve onto a pulmonary valve stent, transferred the valve to the mitral valve annulus and then reestablished the outflow tract of the right ventricle. The other 10 sheep in the control group underwent bioprosthetic valve replacement routinely. Ultrasonic cardiogram (UCG) was employed 6 hour after operation to measure the effective orifice area (EOA) of the mitral valve, mitral peak velocity of early filling, the peak pressure gradient (PPG), the extent of regurgitation, left ventricular enddiastolic dimension (LVEDD) and ejection fraction (EF). Results One sheep in the experimental group died of low cardiac output syndrome; one in the control group died of unmanageable bleeding during operation, and the others all survived. Six hours after operation, UCG of the experimental group showed that the heart valves were well fixed, valve echo was clear, and there was no perivalvular leakage or mitral valve stricture or regurgitation, but moderate pulmonary valve regurgitation occurred in 1 case and mild in 2. There was no significant difference between the two groups in PPG (11.86±1.28 mm Hg vs. 10.98±0.98 mm Hg,t= 1.670,P=0.110) and the mitral peak velocity of early filling (1.72±0.09 m/s vs. 1.65±0.07 m/s, t=1.680,P=0.110). However, EOA of the experimental group was smaller than the control group (2.23±0.09 cm2 vs. 2.39±0.08 cm2, t= 4.240,P= 0.001). Conclusion The experimental result of sheep mitral valves replacement with stentedpulmonary autograft is satisfying. The new mitral valves work well and the surgery method is feasible.
