Objective To improve the efficiency of skin soft tissueexpansion with the overlapping tissue expansion techniques. Methods From June 2003 to March 2005, 5 cases of skin soft tissue defects were treated with the overlapping tissue expansion techniquetwo overlapped expanders in one soft tissue pocket, which was different from the traditional technique——one expander in one soft tissue pocket. Five patients included 3 males and 2 females, aging from 11 to 28 years. The defect was caused by scar of forearm in 2 cases, by melanotic nevus in 1 caseand by cicatricial baldness in 2 cases. The disease course was 1.5 to 24 years. Thedefect size ranged from 12 cm×5 cm to 13 cm×12 cm. Results Skin expansion process was satisfactory and skin defect was completely repaired with the expanded skin tissue in one operation in 5 cases. After operation, the wound of donor-recipient site healed by first intention. All patients were followed up from 3 to 15months, no contracture, pigmentation and scar occurred at the expanded skin area. The long-term appearances were satisfactory. Conclusion Compare with the traditional tissue expansion techniques, the new overlapping tissue expansion techniques can apparently improve the efficiency of skin soft tissue expansion. Itis suitable for the patients whose expandable skin is limited or no more skin tissue can be dissected near the skin defect and who need more expandable skin torepair skin defect.
Objective To investigate clinical features and treatment strategy of cardiac complications caused by permanent pacemaker （PPM） implantation.?Methods?We retrospectively reviewed clinical records of 10 patients with cardiac complications caused by PPM who received surgical treatment in General Hospital of People’s Liberation Army from January 2003 to May 2010. There were seven males and three females with an average age of 62.9 years. One patient had an Atrial demand inhibited pacemaker （AAI） PPM and the other nine patients had a DDD PPM. Cardiac complications included infective endocarditis （IE） in 5 patients, tricuspid insufficiency （TI） in 4 patients and pulmonary artery thrombosis in one patient. According to their respective situation, these patients underwent different surgical treatment such as tricuspid valve plasty （TVP）， tricuspid valve replacement and/or removal of PPM lead and vegetations as part of intensive debridement of the infected area.?Results?Postoperatively， all the patients were successfully discharged. Five patients whose PPM lines and leads were preserved in the surgery had normal PPM function. Three PPM-dependent patients whose PPM leads were removed in the surgery received a PPM reimplantation later. Nine patients were followed up for an average of 5.5 months and all these patients had a significantly improved quality of life. One patient after TVP had mild TI during follow-up. Conclusion Surgical treatment should be performed as early as possible when infection is too severeto control in patients with IE caused by PPM. PPM-induced TI may be hard to be diagnosed preoperatively, and transesophageal echocardiography or surgical exploration should be considered to establish the diagnosis. Measures should be taken to protect PPM if PPM lines and leads are preserved during operation. Patients whose PPM lines and leads are removed during the surgery need to choose a suitable time for PPM reimplantation.