Objective To investigate the operative technique and the effectiveness of perforator flaps for the treatment of elderly patients with ischia-sacral ulcers. Methods Between January 2005 and June 2010, 29 elderly patients with ischia-sacral ulcers were treated. There were 16 males and 13 females, aged from 61 to 75 years (mean, 68 years), including 11 cases of degree III and 18 cases of degree IV according to the standard of the National Pressure Ulcer Advisory Panel(NPUAP). The disease duration was from 5 months to 10 years (median, 5.5 years). The size of ulcers ranged from 7 cm × 6 cm to 12 cm × 10 cm. Of them, 8 cases were companied by cerebral vascular disorders, 6 cases by Alzheimer disease, 11 cases by paraplegia, and 4 cases by others. The flap size ranged from 8 cm × 6 cm to 14 cm × 12 cm. The donor sites were sutured directly. Results Distal flap necrosis occurred in 3 cases (10.3%) 2 days after operation and healed after symptomatic treatment, and the remaining flaps survived and wound healed by first intention with first intention rate of 89.7%. The incisions of donor sites healed primarily. Two cases (6.9%) had infection 1 week after operation and 1 case (3.4%) had wound dehiscence 10 days after operation. Twenty-seven patients were followed up 6 months to 5 years (mean, 3 years). Two cases recurred at 1 and 3 years after operation, respectively. One died of infection, and the other healed by debridement and suture. The flaps of other patients had good texture, color, and elasticity. Conclusion As long as the indications are controlled strictly, good effectiveness can be achieved in the treatment of elderly patients with ischia-sacral ulcers by using perforator flaps.
【摘要】 目的 应用彩色多普勒血流成像技术（CDFI）对下肢皮瓣移植术前供区血管进行检测，掌握血管的来源走行、分布规律、体表的定位及血流动力学特点，为皮瓣设计提供依据。 方法 2005年1月-2009年7月，采用CDFI技术对38例下肢皮瓣内深部动脉干及其肌皮穿支动脉血管的数目、内径、走行方向及分布范围等形态学表现进行检测和血流动力学定量分析。 结果 检出供区皮瓣内深部动脉干38条，肌皮穿支动脉72条。手术所见与此一致。38例皮瓣全部成活。 结论 CDFI显像客观，简便易行，判断血管走行及功能可靠，能够准确测定下肢血管穿出部位和血管内径，对临床皮瓣设计，具有重要参考价值。【Abstract】 Objective The color Doppler ultrasound was used to assess the design of lower limbs flaps and to understand the vessel distribution of the skin flaps, so as to provide basis for design of skin flap. Methods Between January 2005 and July 2009, 38 patients were enrolled in this study and the blood supply of their lower limbs prepared to design skin flap was analyzed by color Doppler flow imaging(CDFI), and the vascular diameter and blood stream distribution were observed respectively. The quality of the blood vessel and its flowing dynamics were measured. Results Before operation, the blood vessel in donor areas had been completely found(100%), and then the artery was verified by operation.For the skin flap in the donor areas, 38 branches of arteries were deep, 72 branches were shallow.The quality of the blood vessels by the color Doppler flow imaging was consistent with the results of operation. Conclusion The color Doppler flow imaging could show the quality of the blood vessels inside the donor area accurately.It is a premier choice for lower limb vascular examination for the design of skin flap.
【摘要】 目的 探讨垂直上蒂法乳房缩小整形术在治疗巨乳症中的改良应用。 方法 2007年1月-2009年10月对18例乳房肥大患者行垂直上蒂法乳房缩小整形术，设计乳晕下做垂直切口，乳房下皱襞上1～2 cm做弧形切口;乳晕上新乳头区域去皮制皮下蒂，切开形成左右两侧皮瓣，乳头乳晕垂直向上折叠缝合于新乳头位置，逐步分次去除多余皮肤及乳腺组织，不悬吊固定切除后的乳腺组织，向中央收紧乳房，获得轮廓饱满、曲线圆滑的新乳房。 结果 手术效果良好，乳房外形饱满，轮廓曲线圆滑，随访半年后乳头乳晕感觉恢复良好，切口瘢痕小，患者满意。 结论 此改良法治疗中重度巨乳症术后乳房形态效果满意，设计与手术操作简便，值得推广。【Abstract】 Objective To explore the improved application of vertical superior pedicle breast reduction mammaplasty in macromastia treatment. Methods Between January 2007 to October 2009, arc incision above submammary fold 1 - 2 centimeters and vertical incision through inferior mammary areola were designed.New mamillary region skin superior mammary areola was deepithelialized and formed subcutaneously pedicle.Mammary areola and nipple subcutaneously pedicle were vertically upward plicating sutured to form new nipple area, the redundant skin and mammary gland were gradually excised, and obtained a new saponaceous curved mammary. Results Totally 18 cases (36 mammaries) were performed by this method.After 6 months’ follow-up, the results showed that new mammaries had good shape, saponaceous outline and little scar in incision, sensation on mammary nipple and areola recovered.All patients were satisfied with the postoperative results. Conclusion Improved vertical superior pedicle breast reduction is an ideal breast reduction method for moderate and severe macromastia, and the technique is convenient in design and operation.
Objective To investigate the effects of the misshapen auricular chondrocytes from microtia in inducing chondrogenesis of human adipose derived stem cells (ADSCs) in vitro. Methods Human ADSCs at passage 3 and misshapen auricular chondrocytes at passage 2 were harvested and mixed at a ratio of 7 ∶ 3 as experimental group (group A, 1.0 × 106 mixed cells). Misshapen auricular chondrocytes or ADSCs at the same cell number served as control groups (groups B and C, respectively). All samples were incubated in the centrifuge tubes. At 28 days after incubation, the morphological examination was done and the wet weight was measured; the content of glycosaminoglycan (GAG) was detected by Alcian blue colorimetry; the expressions of collagen type II and Aggrecan were determined with RT-PCR; and HE staining, toluidine blue staining, Safranin O staining of GAG, and collagen type II immunohistochemical staining were used for histological and immunohistochemical observations. Results At 28 days after incubation, all specimens formed disc tissue that was translucent and white with smooth surface and good elasticity in groups A and B; the specimens shrank into yellow spherical tissue without elasticity in group C. The wet weight and GAG content of specimens in groups A and B were significantly higher than those in group C (P lt; 0.05), but no significant difference was found between groups A and B in the wet weight (t=1.820 3, P=0.068 7) and in GAG content (t=1.861 4, P=0.062 7). In groups A and B, obvious expressions of collagen type II and Aggrecan mRNA could be detected by RT-PCR, but no obvious expressions were observed in group C; the expressions in groups A and B were significantly higher than those in group C (P lt; 0.05), but no significant difference was found between groups A and B in collagen type II mRNA expression (t=1.457 6, P=0.144 9) and Aggrecan mRNA expression (t=1.519 5, P=0.128 6). Mature cartilage lacunas and different degrees of dyeing for the extracellular matrix could be observed in groups A and B; no mature cartilage lacunas or collagen type II could be observed in group C. The expression of collagen type II around cartilage lacuna was observed in groups A and B, but no expression in group C; the gray values of groups A and B were significantly lower than that of group C (P lt; 0.01), but no significant difference was found between groups A and B (t=1.661 5, P=0.09 7 0). Conclusion Misshapen auricular chondrocytes from microtia can induce chondrogenic differentiation of human ADSCs in vitro.