OBJECTIVE: To summarize the importance of surgical management to repair vascular injury in limbs salvage, and to analyze the influence factors in the management. METHODS: From 1993 to 2000, 42 cases of 58 vascular injuries were reviewed; there were 37 males and 5 females, aging from 12 to 70 years old. Emergency operations were performed in 38 cases and selective operations in 4 cases from 1 hour to 45 days after injury. There were 22 cases of complete rupture in 32 blood vessels, 5 cases of partial rupture in 6 blood vessels, and 15 cases of vascular defect in 20 blood vessels, with 5 cm to 10 cm defect. The operation management included end-to-end anastomosis in 22 cases, side-to-end anastomosis in 1 case, vascular repair in 5 cases and vascular grafting in 14 cases. All of the cases were followed up for 6 months to 7 years. RESULTS: In those received emergency operations, it was successful in 35 cases, with amputation in the other 3 cases; after operation, there were 5 cases of post-operative angio-crisis, 1 case of hematoma and 1 case of pseudoaneurysm. In those received selective operation, all succeeded but 1 case of post-operative angio-crisis. After the follow-up, except for 3 cases of amputation, the other limbs survived; and function of the survived limbs recovered satisfactorily after operation except poor recovery in 7 cases of replantation of the limbs. CONCLUSION: To repair vascular injury immediately, to manage angio-crisis and to remove influence factors is the key to save the injured limbs and to maintain the function of them.
Objective To evaluate repair and reconstructionof the femoral pseudoaneurysm caused by drug injection. Methods From May 2000 to May 2005, 15 cases of femoral pseudoaneurysm caused by drug injection underwent operation treatment. All patients were male, aging 20-36 years. The disease course was 18-52 days(mean 35 days) and the course of druginjection was 3-17 months. The locations were the left side in 5 cases and theright side in 10 cases. After having been bandaged with pressure and supportedwith nutrition, they had been all operated. One case received fistula repair, and 14 cases received vascular grafting with ePTFE man-made blood vessel. Results The wounds healed by the first intention in 14 cases. All limbs survived. The complexion, temperature and response of involved leg were in gear. The postoperative color ultrasound Doppler detection showed that all the vascular grafts were of patency. The function of the involved limbs restored to normal. Conclusion Complete debridement, vascular reconstruction and better microsurgery skill were the key factors of treating successfullythe femoral pseudoaneurysm caused by drug injection.
Objective To explore the clinical effect of different types of free tissue transplantation on repairing tissue defects and reconstructing functions. Methods From November 2001 to September 2004, 14 types of freetissue transplantation and 78 free tissue flaps were applied to repairing tissue defects and reconstructing functions in extremities and maxillofacial region in 69 cases. Of the 69 cases, there were 53 males and 16 females (their ages ranged from 18 to 56, 31 on average). Five cases were repaired because of skin defects in foot, 22 cases were repaired because of skin defects in leg, 36 cases were repaired as the result of skin defects in hand or forearm and finger reconstruction, 3 cases were restored by virtue of ulna or radius defects, and 3 cases were repaired in maxillofacial region. There were 55 cases of open wound, in which 16 cases were infectious wound, 6 cases were osteomyelitis or pyogenic arthritis. There were 14 cases of noninfectious wound. The area of these tissue flaps ranged from 2.0 cm×1.5 cm to 43.0 cm×12.0 cm. The length of bone transplantation ranged from 10 cm to 15 cm. Results Arterial crisis occurred in 2 cases, venous crisis occurred in 2 cases.Seventysix flaps survived completely and 2 flaps survived partially which werelater healed. Fiftytwo cases were healed at stageⅠ, 13 cases were healed at stageⅡ(healing time ranged from 20 to 30 days), purulent infection occurred to 4cases(healing time ranged from 3 to 11 months). Bone healing time ranged from 6 to 8 weeks in finger reconstruction. Bone healing time ranged from 4 to 6 months in fibula transplantation. The function reconstruction and appearance were satisfying. The functions of all regions, where free tissues were supplied, were not disturbed. Conclusion Tissue transplantation and composite tissue transplantation are effective in repairing tissue defects and reconstructing functions.
Objective To construct a tissue engineering skin containing capillary-like network by employing tissue engineering method.Methods The numan umbilical vein endothelial cells(HUVECs) were isolated from a new-born umbilical cord. The keratinocytes and dermal fibroblasts were isolated from a new-born foreskin biopsy. After thecollagen gelwas prepared, the fibroblasts and the vascular endothelial cells were added in a ratio of 1 to 1 to construct a skin substitute containing capillary-like network. The skin substitute was observed by HE staining and immuno histochemical staining (Ⅷ factor). The reconstructed skin containing capillary-like network was used to repair the nude mice skin defects in the experimental group. The tissue engineering skin containing no vascular endothelial cells was used in control group.Results Capillary-like network could be observed inthe dermal layer of the tissue engineering skin, and the nude mice skin defectswere repaired by the skin substitutes in the experimental group. In control group, no capillary-like network was found.Conclusion The tissue engineering skin containing capillary-like network is successfully constructed in vitro and can be used to repair the full-thickness skin defects.
OBJECTIVE: To report repair and reconstruction of massively damaged wound under unusual condition. METHODS: One hundred and forty-seven patients with deep tissue defects were admitted from January 1993 to December 2000, among them, 96 cases suffered from electrical injury, 18 cases with hot press injury, 18 cases with deep burns as a result of CO poisoning or epileptic seizure, 6 cases caused by chemical producing necrosis and wound infection, 3 cases with radiation injuries, 2 cases with chemical burn, 2 cases with explosive injury, 2 cases with frostbite. One hundred and seventy five wounds in 147 patients were repaired by transfer of local flap, forearm conversal island skin flap, pectoralis major myocutaneous flap, delto-pectoral skin flap, latissimus dorsi skin flap, gastroecnemius myocutaneous flap, anterior and posterior tibial artery island skin flap, and so on. The wound defect ranged from 1 cm x 1 cm to 20 cm x 28 cm, and the flaps were 1.5 cm x 2.0 cm to 22 cm x 30 cm. The necrotic tendon was replaced with acellular allogenic tendon simultaneously in 7 cases. RESULTS: One hundred and sixty-nine flaps were survival with first intention, while necrosis of the tip of flap occurred in 6 cases. The transplantation of acellular allogenic tendon in all cases were survival. The function and configuration in 28 cases were satisfactory after 4 months to 8 years follow-up. CONCLUSION: Various types of flaps are choosen according to the position, defect range and degree of wound, which is an ideal method to restore the function and to improve patients’ living condition.
In order to repair palpebral defects resulted from various causes, frozen tarsus of eyelid from newborn was used. From Jan. 1993 to Feb. 1995, the frozen preserved tarsus of eyelid from new-born was used to repair the palpebral defect in 10 cases. These defects were resulted following operation in traumatic defect in 5 cases, tramatic defect in 3 cases and congenital defect in 2 cases. After 3 month to 3 years follow-up, no refection reaction was found and no complication was occurred. The external appearance following repair was good. The overall successful rate was 100%. It was suggested that the frozen preserved tarsus from new-born was a safe and reliable material in the repair of palpebral defects.
The soft-tissue-cutaneous flap adjacent to the abdominal incisional hernia was ultilized to repair huge hernia in 6 cases with success. Patients were followed up for 2y7 years without recurrence. The operative planning, the technique and the matters needing attention were introduced in details. The soft tissues and skin adjacent to hernia used for repair was easy to obtain and a simple technique. The adoption of this operation in hospitals at the grassroots level was feasible.
To summarize the effectiveness of the improv ed surgical techniques in fasciocutaneous flaps of the limbs. MethodsFrom February 1999 to December 2005, 58 patients (39 males, 19 females, aged 1068 years) underwent repairs of the skin defects with improved fasciaocu taneous flaps of the limbs. Twentyone patients had the skin defects in front of the tibial bone in the middle and lower parts, 12 patients had the skin defect s in the heels, 16 patients had the skin defects in the ankles, 3 patients had t he skin defects around the knees, 1 patient had a wide sacrococcygeal bedsore, and 5 patients had the skin defects in the wrists and hands. The wounds ranged in size from 5 cm×3 cm to 18 cm× 12 cm. According to the wound lo cations, the following flaps were selected: 4 cutaneous antebrachii medialis nerve and basilic vein fasciocutaneous flaps, 1 cutaneous antebrachii lateralis nerve and cephalic vein fasciocutaneous flap, 3 saphenous nerve and great saphenousvein fasciocutaneous flaps, 1 cutaneous nerve of thigh posterior fasciocutaneous flap, 32 reverse sural nerve and saphenous vein fasciocutaneous flaps, and 17 reverse saphenous nerve and great saphenous vein fasciocutaneous flaps. The dissected flaps ranged in size from 6 cm× 4 cm to 18 cm× 13 cm. The donor wounds underwent straight sutures in 39 patients, and the skin grafting (6 cm×3 cm to 13 cm× 6 cm) was performed on 19 patients after the donor wounds were closed. Results The wounds healed by first intention, and the flaps survived completely in 54 patients. The flaps developed partial necrosis in 4 patients. The followup for 120 months (average, 8 months) revealed that the flaps had a satisfactory appearance with a soft texture and the function was also satisfactory. Conclusion A fasciocutaneous flap of the limbs is an ideal flap for repairing defects in the skins and soft tissues of the limbs. The survival rate of the flap can be further improved by an improvement of the surgical techniques.
Objective To investigate the clinical efficiency of thedistally based sural island flap and myofasciocutaneous flap in reconstruction of defect and osteomyelitic cavity of the ankle and foot. Methods From June 1997 to October 2004, 21 patients with soft tissue defects and osteomyelitis in the ankle and foot were treated with the distally based sural island flap and myofasciocutaneous flap. There were 20 males and 1 female aging from 6 to 78 years. The defect was caused by soft tissue defect trauma(18 cases) and electrical injury ( 3 cases). Among 21 patients, 17 were treated with island flaps, 4 by the myofasciocutaneous flap. The size of flaps ranged from 4 cm×5cm to 16 cm×22 cm. The donorsites were closed directly in 4 cases. Results The flaps completely survived in 21 cases and healing by first intention was achieved. After a follow-up of 36 months, no complication occurred. The color and texture of the flaps were good. The appearance and the function were satisfactory. Conclusion Distally basedsural flap is a reliable flap. This flap has rich blood supply without sacrifice of major arteries. Flap elevation is easy. It is very useful in repairing large soft tissue defects of the lower leg, the ankle and the foot, especially inrepairing deep soft tissue defects and osteomyelitic cavities .
OBJECTIVE To investigate the effects of basic fibroblast growth factor(bFGF) on repairing transected sciatic nerves in rats. METHODS The animal models of the transected sciatic nerve of 40 SD rats were established, which divided into 4 groups: normal saline (NS) group, nerve growth factor (NGF) group, bFGF group and normal control group. The epineurium of the transected sciatic nerve was sutured under microscope, then bFGF or NGF was dropped into local sites and injected intramuscularly once a day for 30 days after operation. Functional repair for the transected sciatic nerves was studied by nerve conductive velocity (NCV) and sciatic nerve function index (SFI). RESULTS As a criterion, the level of the normal control group was regarded as zero, SFI of NS group, NGF group and bFGF group were -114.30 +/- 10.34, -70.50 +/- 11.01, -50.45 +/- 7.82 respectively at 1 month after operation, and they were -54.96 +/- 16.46, -35.21 +/- 10.80, -27.53 +/- 11.23 respectively in 3 months after operation. NCV of bFGF group was significantly faster than NS group and NGF group. CONCLUSION bFGF can significantly promote the functional repair of injured peripheral nerve, and its effects are better than NGF.