ObjectiveTo investigate the effectiveness of the mortise-tenon orbicularis oris muscle flap for philtrum column deformity secondary to the unilateral cleft lip repair. MethodsBetween January 2009 and August 2011, 43 patients with philtrum column deformity secondary to unilateral cleft lip repair were treated. There were 23 males and 20 females with an average age of 23.6 years (range, 18-31 years). The left philtrum column was involved in 26 cases, and the right side in 17 cases. Cleft lip was repaired with Millard I in 15 cases and with Millard II in 28 cases. The time between cleft lip repair and philtrum column deformity correction was 15-30 years (mean, 21.7 years). The bilateral double orbicularis oris muscle flap was obtained, and then was divided horizontally into two layers. The overlapping suture of the bilateral lower muscle flap was perfomed, and the upper layer muscle was designed into the mortise-tenon orbicularis oris muscle flap and was sutured with contralateral skin. ResultsAll incisions healed by first intention. Forty cases were followed up 13.4 months on average (range, 6-34 months). The patients achieved satisfactory effects in bilateral symmetry philtrum column and normal concave shape. At 6 months after operation, significant improvement was observed in 38 cases and no obvious improvement in 2 cases. ConclusionThe mortise-tenon orbicularis oris muscle flap is a simple operation and can obtain good results in the appearance and function of the upper lip in the correction of philtrum column deformities secondary to the unilateral cleft lip repair.
ObjectiveTo explore the clinical application and effectiveness of a personalized tissue engineered cartilage with seed cells derived from ear or nasal septal cartilage and poly-glycolic acid (PGA)/poly-lactic acid (PLA) as scaffold in patients with nasal reconstruction. MethodsBetween March 2014 and October 2015, 4 cases of acquired nasal defects and 1 case of congenital nasal deformity were admitted. The patient with congenital nasal deformity was a 4-year-old boy, and the source of seed cells was nasal septal cartilage. The other 4 patients were 3 males and 1 female, aged 24-33 years, with an average of 28.5 years. They all had multiple nasal subunit defects caused by trauma and the source of seed cells was auricular cartilage. The tissue engineered cartilage framework was constructed in the shape of normal human nasal alar cartilage and L-shaped silicone prosthesis with seed cells from cartilage and PGA-PLA compound biodegradable scaffold. The boy underwent nasal deformity correction and silicone prosthesis implantation in the first stage, and the prosthesis was removed and implanted with tissue engineered cartilage in the second stage; the remaining 4 adult patients all used expanded forehead flaps for nasal reconstruction. All 5 patients underwent 1-4 nasal revisions. The implanted tissue engineered cartilage was observed during the operation and taken from 2 patients for histological examination.ResultsAll the incisions healed by first intention after the tissue engineered cartilage implantation, and the expanded forehead flaps survived. Postoperative low fever occurred in 3 patients. No complications such as infection, obvious immune rejection response, and tissue engineered cartilage protrusion were found in all patients. All patients were followed up 9-74 months (mean, 54.8 months). During follow-up, the patients had no obvious discomfort in the nose and the ventilation function were good. All patients were satisfied with the nasal contour. Early-stage histological examination showed the typical cartilage characteristics in 1 patient after the implantation of tissue engineered cartilage. Late-stage histological examination in 1 patient of tissue engineered cartilage showed the characteristics of fibrous connective tissue; and the other showed there was remaining cartilage.ConclusionThe safety of tissue engineered cartilage constructed in vitro for reconstruction is preliminarily confirmed, but the effectiveness still needs further verification.
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.
【Abstract】 Objective To review the progress in the research of complications after expansive laminoplasty such as axial symptom, kyphotic deformity, and segmental motor paralysis. Methods Recent articles about complications after expansive laminoplasty were reviewed, and comprehensive analysis was done. Results The pathogenesis of axial symptom, kyphotic deformity, and segmental motor paralysis has not yet fully been understood, but has brought new finding, such as the importance of the spinous process-ligament-muscle complex, C5 palsy theory, and the involvement of the spinal cord mechanism. Conclusion The pathogenesis of axial symptom, kyphotic deformity, and segmental motor paralysis should be further investigated to prevent and treat the complications.
OBJECTIVE: To evaluate the effectiveness of the Bridle procedure in treatment of foot deformity in children with slight cerebral spastic paralysis. METHODS: From February 1993 to April 1999, 32 cases with 57 deformed feet, due to slight cerebral spastic paralysis, which included 20 males and 12 females, ranging from 4 to 14 years old, were reported after 6 to 74 months’ follow-up, averaging 38 months. Bilateral feet were involved in 25 cases and unilateral feet involved in 7 cases. The deformities in all feet, including 26 feet of acroceph-foot deformity in 15 cases, 13 equinovarus deformity in 8 cases and 18 scissors gait deformity in 9 cases, were treated by Bridle procedure, followed by temporal external fixation of long-leg plaster splint for 6 to 8 weeks. RESULTS: Clinical observation revealed complete and permanent correction of deformity in 48 out of all 57 feet (84.2%), reoccurrence of deformity in 7 feet (12.3%), and occurrence of valgus deformity in 2 feet (3.5%). No joint stiffness was observed. CONCLUSION: The Bridle procedure is an easily performed operation and effective in the treatment of foot deformity in children with slight cerebral spastic paralysis
Objective To explore the feasibility of combining high level Le Fort Ⅰ osteotomy with bone grafting in the same operation for correction of secondary midface deformities in cleft patients. Methods From January 2002 to January 2005, 10 patients suffering from secondary midface deformities were treated. There were 4 males and 6 females, aged from 16 to 32 years. The unilateral cleft was involved in 8 patients and the bilateral cleft in2 patients. All patients received combining high level Le Fort Ⅰ osteotomy with bone grafting in the same operation. The horizontal corticotomy of high level Le Fort Ⅰosteotomy on anterior wall of maxillary bone is higher than that of traditionalLe Fort Ⅰ osteotomy, it is only 5 mm close to infraorbital foramen. Results All 10 patients were satisfied with their appearances after operation. Dental articulation was improved greatly in 9 patients. With an X-ray re-examination, maxillary was returned to normal position in all patients. After a follow up from 6months to 2 years, dental arch had good appearance. The X-ray films showed no obvious bone absorption. The density of grafting bone was approximation to the normal bone.Conclusion High level Le Fort Ⅰ osteotomy can make notonly maxillary advance, but also regions of lateral and floor of nose and partial infraorbital region advance. Combining with bone grafting in the same operation can decrease the frequency of operation, save the treatment expense and obtain an ideal effect. So it is an effective method for correction of the secondary midface deformities in cleft patients.
Objective To assess the efficacy of the extra long scapular-lateral thoracic-il ioinguinal siamese flap to repair the contracture deformity of perineal scar caused by burn and to discuss its characteristics. Methods From January2008 to August 2009, 9 patients with contracture deformity of perineal scar after deep II degree to III degree burn were treated. There were 7 males and 2 females aged from 22 to 54 years (35.4 years on average). The course of disease ranged from 8 months to 5 years. All cases had central type of perineal scar. Among the cases, 3 cases were compl icated by abdominal scar, 4 cases by legs scar, and 2 cases by abdominal and legs scar. Scar ulcer was observed in 2 cases. The opening-closing angle of bilateral lower extremities was (29.4 ± 8.8)°. And anus could not expose entirely so that squatting and rel ieving the bowels were difficult in 6 cases. Defect areas after scar resection ranged from 20 cm × 6 cm to 28 cm × 8 cm. The size of extra long scapular-lateral thoracic-il ioinguinal siamese flap ranged from 35 cm × 12 cm to 58 cm × 15 cm. The donor sites were sutured directly. Results Bl ister and necrosis occurred in 1 case and was cured after dressing changed, and others flaps survived with wounds primary heal ing. Incision at donor site healed by first intention. All cases were followed up 6-12 months. The perineal function improved and the partial deformities were corrected. The opening-closing angle of bilateral lower extremities increased to (75.6 ± 11.3)°, showing significant difference between pre- and post-operation (P lt; 0.05). The functions of squatting and rel ieving the bowels recovered well. The perineal scar adhesion recurred in 2 cases after 6 months of operation and were cured after scar resectionand expanding flaps transposition. Conclusion In view of large donating region, great facil ity for transposition, stableand sufficient blood supply, reutil ization as expanded flap, it was an effective treatment and a beneficial trial by applying the transposition of the extra long scapular-lateral thoracic-il ioinguinal siamese flap for contracture deformity of perineal scar caused by burn.
ObjectiveTo evaluate the clinical results of uncemented total hip arthroplasty (THA) for ultimate hip disease combined with proximal femoral deformity.
MethodsBetween February 2005 and June 2013, 48 cases (51 hips) of ultimate hip disease combined with proximal femoral deformity were treated with uncemented THA and osteotomy. There were 14 males (16 hips) and 34 females (35 hips), with an average age of 52 years (range, 19-83 years). Unilateral hip was involved in 45 cases, and bilateral hips in 3 cases. There were 36 cases (39 hips) of developmental dysplasia of hip, 3 cases (3 hips) of traumatic arthritis, 1 case (1 hip) of previous intertrochanteric valgus osteotomy, 4 cases (4 hips) of internal fixation failure, 3 cases (3 hips) of tuberculosis, and 1 case (1 hip) of suppurative infection. Preoperative Trendelenburg sign was positive in all hips. The discrepancy of limbs was observed in 19 patients. According to Berry classification system, deformity located at the greater trochanter in 4 hips, at the femoral neck in 39 hips, at the femur metaphysis in 7 hips, and at femoral shaft in 1 hip. The Harris score was 34.28±3.28 before operation.
ResultsHealing of incision by first intention was obtained in all patients. Deep venous thrombosis occurred in 1 patient, and no complications of infection, neurovascular injury, or prosthetic dislocation were found. Forty-seven patients (50 hips) were followed up 3.8 years on average (range, 1-9 years). At last follow-up, the Harris hip score was 92.87±4.57, showing significant difference when compared to preoperative score (t=-213.19, P=0.00). Postoperative Trendelenburg sign was positive in 6 hips. Normal gait was shown in 39 cases, and slight limp in 8 cases. X-ray film results showed complete correction of deformity and bony fusion at the osteotomy sites at 3 to 6 months (mean, 4.4 months) after operation. At last follow-up, all the femoral and acetabulum components showed radiographic evidence of bone ingrowth. Osteolysis was observed in Gruen zones 1 and 7 around the femoral prosthesis of 2 cases. There was no case of prosthesis loosening.
ConclusionThe biological fixation of the femoral stem prosthesis combined with corrective osteotomy can attain satisfactory result for ultimate hip disease combined with proximal femoral deformity in THA.
Objective To discuss the operative method and therapeutic effect of correcting nasal deformity after prothesis of unilateral complete harel ip with design of nasal subunits. Methods From January 2006 to December 2008, 18 patients with nasal deformity after prothesis of unilateral complete harel ip were treated. There were 7 males and 11 femalesaged 6-26 years old. The deformity located on the left side in 11 cases and the right side in 7 cases with major manifestations of deviation and crispation towards normal side of nasal columella, applanation and collapse of nasal ala, lenity and dyssymmetry of nostrils, malposition of basement of nasal ala. Time between harel ip prothesis and secondary epithesis was 4-21 years (average 8 years). During epithesis, nasal columella were extended, collapse nasal alar cartilages were l iberated and fixed in symmetrical positions, injured upper l ip was extended with nasolabial flap or to “tongue-l ike” flap on nasal base. Eleven cases were implanted L-type sil icone prothesis to hump nose. Results For 1 case suffered postoperative rejection, the implant of L-type sil icone prothesis was taken out promptly, and reimplant of prothesis was performed 6 months later without postoperative rejection. The incision of the other patients all healed by first intention without any postoperative compl ications. The effect of epithesis was good with such manifestations as the eminence of injured nasal ala, normal radian, and symmetrical nostils. All patients werefollowed up for 3 months-2 years (average 8 months). The incision was hidden with well-maintained appearance and no obvious scar. Conclusion Based on feature of nasal subunits and formation causes of deformity, individual-orientated epithesis design of nasal ala margin, nasal columella basement incisions, reset and fix nasal alar cartilages and tissues values can provide the patients suffering the secondary nasal deformity with satisfied appearance.
The "bayonet" deformity from poliomyelitis is a peculiar type of deformity of knee. From January 1986 through December 1994, 23 cases of this type of knee deformity were corrected by surgery. The operative procedures performed were suprachondylar osteotomy of femur or subplateau osteotomy of tibia. The patients were followed up from 1 to 5 years, with an average of 3 years. The result rated excellent to good was 95.6%. The features of this disorder and the main points in the surgical procedure were discussed.
