目的 探索乳腺癌术中胸壁皮肤缺损的植皮技术，以寻求满意的方法。方法 对134例乳腺癌患者手术切除后的胸壁皮肤缺损采用自体下腹全厚皮片植皮覆盖创面，观察其成活情况及承受放疗的能力。结果 植皮成活率为97%，并且其结构完整，功能好，放疗一个疗程后无1例发生皮片破溃坏死。结论 对于乳腺癌手术中有胸壁皮肤缺损的患者，采用自体下腹全厚皮片植皮术来覆盖创面，其方法简单，成活率高，皮肤结构完整，功能好，同时对患者的腹部有一定的美容效果，患者易于接受，有推广价值。
【Abstract】 Objective To explore the effect of early scrotal dermatoplasty on spermatogenic functional rehabilitation of testis in juvenile pigs with third degree burn wound of the scrotum. Methods Thirty healthy male Guizhou miniature pigs (weighing 10-15 kg, 2-month-old) were divided into 3 groups: control group (group A, n=10), natural healing group (group B, n=10), and dermatoplasty group (group C, n=10). In group A, the pig was not given any treatment; after third degree burn model of the scrotum was prepared, wounds were not treated in group B and the burn skin was excised and whole hypogastric pachydermia was used for dermatoplasty in group C. At 3 months and 1 year after model preparation, bilateral testis were collected from 5 pigs, respectively. HE staining was performed to observe the effects of different repair method on the morphology of spermatogenic cells and immunohistochemical staining was used to detect Survivin protein expression. Results All pigs survived to the end of the experiment and the wound healed successfully. Histological observation showed that spermatogenic cells had normal shape at all stages and mature sperms were seen in lumens in group A; the thickness of seminiferous epithelium was thinner, having one layer or two layers of spermatogenic cells in group B; the spermatogenic cells in group C were slightly more than that in group B with some spermatids; and in groups B and C, the spermatogenic cells at 1 year were more than that at 3 months. Immunohistochemistry staining showed that the Survivin protein expression in groups B and C was less than in group A, and group B was less than group C, showing significant differences at 3 months and 1 year (P lt; 0.05), but no significant difference between 3 months and 1 year in the same group (P gt; 0.05). Conclusion Dermatoplasty has inhibitory effect on spermatogenic functional rehabilitation of testis. Dermatoplasty can decrease spermatogenic cells and reduce Survivin protein expression, but some spermatids still survive in seminiferous tubule.
Objective To observe the effectiveness of vacuum seal ing drainage (VSD) combined with anti-takenskin graft on open amputation wound by comparing with direct anti-taken skin graft. Methods Between March 2005 andJune 2010, 60 cases of amputation wounds for limbs open fractures were selected by using the random single-blind method.The amputation wounds were treated with VSD combined with anti-taken skin graft (test group, n=30) and direct anti-takenskin graft (control group, n=30). No significant difference was found in age, gender, injury cause, amputation level, defect size,preoperative albumin index, or injury time between 2 groups (P gt; 0.05). In test group, the redundant stump skin was usedto prepare reattached staggered-meshed middle-thickness skin flap by using a drum dermatome deal ing after amputation,which was transplanted amputation wounds, and then the skin surface was covered with VSD for continuous negative pressuredrainage for 7-10 days. In control group, wounds were covered by anti-taken thickness skin flap directly after amputation, andconventional dress changing was given. Results To observe the survival condition of the skin graft in test group, the VSDdevice was removed at 8 days after operation. The skin graft survival rate, wound infection rate, reamputation rate, times ofdressing change, and the hospital ization days in test group were significantly better than those in control group [ 90.0% vs.63.3%, 3.3% vs. 20.0%, 0 vs. 13.3%, (2.0 ± 0.5) times vs. (8.0 ± 1.5) times, and (12.0 ± 2.6) days vs. (18.0 ± 3.2) days, respectively](P lt; 0.05). The patients were followed up 1-3 years with an average of 2 years. At last follow-up, the scar area and grading, and twopointdiscrimination of wound in test group were better than those in control group, showing significant differences (P lt; 0.05).No obvious swelling occurred at the residual limbs in 2 groups. The limb pain incidence and the residual limb length were betterin test group than those in control group (P lt; 0.05). Whereas, no significant difference was found in the shape of the residual limbs between 2 groups (P gt; 0.05). In comparison with the contralateral limbs, the muscle had disuse atrophy and decreasedstrength in residual limbs of 2 groups. There was significant difference in the muscle strength between normal and affected limbs(P lt; 0.05), but no significant difference was found in affected limbs between 2 groups (P gt; 0.05). Conclusion Comparedwith direct anti-taken skin graft on amputation wound, the wound could be closed primarily by using the VSD combined withanti-taken skin graft. At the same time it could achieve better wound drainage, reduce infection rate, promote good adhesion ofwound, improve skin survival rate, and are beneficial to lower the amputation level, so it is an ideal way to deal with amputationwound in the phase I.
Objective To investigate the cl inical effect of Meek technique skin graft in treating exceptionally large area burns. Methods The cl inical data were retrospectively analysed from 10 cases of exceptionally large area burns treated with Meek technique skin graft from April 2009 to February 2010 (Meek group), and were compared with those from 10 casesof exceptionally large area burns treated with the particle skin with large sheet of skin allograft transplantation from January 2002 to December 2006 (particle skin group). In Meek group, there were 8 males and 2 females with an average age of 34.5 years (range, 5-55 years), including 6 cases of flame burns, 2 cases of hot l iquid burns, 1 case of electrical burn, and 1 case of hightemperature dust burn. The burn area was 82.6% ± 3.1% of total body surface area (TBSA). The most were deep II degree to III degree burns. The time from burn to hospital ization was (3.5 ± 1.3) hours. In particle skin group, there were 8 males and 2 females with an average age of 36.8 years (range, 18-62 years), including 5 cases of flame burns, 2 cases of hot l iquid burns, and 3 cases of gunpowder explosion injury. The burn area was 84.1% ± 7.4% of TBSA. The most were deep II degree to III degree burns. The time from burn to hospital ization was (4.9 ± 2.2) hours. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The skin graft survival rate, the time of skin fusion, the systemic wound heal ing time, and the treatment cost of 1% of burn area were 91.23% ± 5.61%, (11.14 ± 2.12) days, (38.89 ± 10.36) days, and (5 113.28 ± 552.44) yuan in Meek group, respectively; and were 78.65% ± 12.29%, (18.37 ± 4.63）days, (48.73 ± 16.92) days, and (7 386.36 ± 867.64) yuan in particle skin group; showing significant differences between 2 groups (P lt; 0.05). Conclusion Meek technique skin graft has good effect in treating exceptionally large area burns with the advantages of high survival rate of skin graft, short time of skin fusion, and low treatment cost of 1% of burn area.
Objective To investigate the expression of c-kit in human intermediate-spl it-thickness skin grafts and normal skin, and to recognize the role of c-kit in hyperpigmented process of the skin grafts. Methods The hyperpigmented intermediate-spl it-thickness skin grafts of 16 patients’ face and cervicum 1 year after operation was harvested and the normal skins around the recipient site and the donor site were used as controls. Envision immunohistochemical technique was usedto detect the expression and distribution of c-kit in the skin grafts and in the normal control skins, respectively. Medical image quantitative analysis system was used to quantitate the positive expression index (PI). Results The expression of c-kit was located in endochylema and cytolemma of melanocytes and keratinocytes in the basilar part of epidermis. The positive expression of c-kit was obvious in the intermediate-spl it-thickness skin grafts and blown zone was observed in the basilar part of epidermis; and was not obvious and local in normal control skins. The PI of c-kit in the intermediate-spl it-thickness skin grafts (131 216 ± 19 130) was significantly higher than that in the normal skin around the recipient site (92 958 ± 16 208) and in the normal skin around the donor site (91 306 ± 8 135); showing statistically significant difference (P lt; 0.05). Conclusion The expression of c-kit in intermediate-spl it-thickness skin grafts increases remarkably compared with that in normal control skin. c-kit may play an important adjusting role in the process of hyperpigmentation of skin grafts．
【Abstract】 Objective To investigate the effects of different surgical methods in treating scalp mal ignanttumors. Methods From January 1995 to September 2004, 70 patients with scalp mal ignant tumor were treated with different surgical methods. There were 41 males and 29 females with an average age of 50.3 years (30-85 years). The course of disease ranged from 2 weeks to 3 years(mean 3.5 months). There were 31 cases of basal cell carcinoma, 24 cases of squamous carcinoma, 8 cases of melanocarcinoma, 4 cases of fibrous sarcoma, 2 cases of l iposarcoma, and 1 case of vasculosarcoma. Leision size ranged from 1.0 cm × 0.5 cm to 10.0 cm × 8.0 cm. Scalp defect ranged from 3 cm × 3 cm to 12 cm × 11 cm after clearing up the tumors. Defect was repaired with free skin transplantation in 51 cases, scalp flap in 12 cases, cervico-shoulder flap in 2 cases, trapizius myocutaneous flap in 3 cases, and radial artery retro-island flap in 2 cases. The flap sizes ranged from 5 cm × 4 cm to 18 cm × 12 cm. Results Of 70 cases, 67 skin flaps survived and incision healed by first intention; 2 flaps necrosed at distal part(lt; 1 cm) and healed by second intention after dressing change; 1 flap infected and was treated with symptomatic medication.All the donor sites healed by first intention. Fifty-five patients were followed up for 1 to 5 years and 5 cases had tumor recurrence. In patients receiving skin transplantation, 1 case of squamous carcinoma and 1 case of fibrous sarcoma relapsed after 1 year and 2.5 years respectively and were given radical resection and skin flap grafting; in patients receiving skin flap grafting, 1 case of vasculosarcoma and 1 case of squamous carcinoma relapsed after 6 months and 3 months respectively, and gave up treatment; 1 case of fibrous sarcoma relapsed after 2 years and was given radical resection and skin flap grafting. The other cases survived and had no tumor recurrence. Conclusion Scalp mal ignant tumors should be diagnosised and treated as early as possible. Clearing up completely by surgery is an effective method.