ObjectiveTo evaluate the clinical experiences and treatment effectiveness of chronic venous insufficiency with venous ulcer in lower limb. MethodsSeventy-eight patients (88 limbs) suffering lower limb chronic venous insufficiency with venous ulcer from May 2004 to April 2011 in this hospital were analyzed retrospectively. All the patients had undergone high ligation for great saphenous vein plus endovenous laser treatment plus subfascial endoscopic perforator vein surgery (SEPS). ResultsPostoperative complications included 3 cases of subfascial haematoma; 2 cases of pneumohypoderma; 3 cases of numbness in anterior tibial and ankle areas. All the ulcers healed between 4 to 6 weeks. Follow up period was between 6 months to 5 years. There was only one recurrence due to residual varicose from ankle area. The mean operation time was 20 min (15－30 min) in SEPS, the average blood loss was 2 ml (1－5 ml), and the mean duration of postoperative hospitalization was 5 d (2－8 d). ConclusionsSEPS is a first treatment choice for CVI with venous ulcer. It has less invasiveness, lower chances for bleeding, shorter operation time, quicker recovery, and fewer complications.
Objective To evaluate the effect of internal fixation on the stability of pedicled fascial flap and the osteogenesis of exceed critical size defect (ECSD) of bone so as to provide theory for the clinical application by the radiography and histology observation. Methods The ECSD model of the right ulnar midshaft bone and periosteum defect of 1 cm in length was established in 32 New Zealand white rabbits (aged 4-5 months), which were divided into group A and group B randomly (16 rabbits in each group). The composite tissue engineered bone was prepared by seeding autologous red bone marrow (ARBM) on osteoinductive absorbing material (OAM) containing bone morphogenetic protein and was used repair bone defect. A pedicled fascial flap being close to the bone defect area was prepared to wrap the bone defect in group A (control group). Titanium miniplate internal fixation was used after defect was repair with composite tissue engineered bone and pedicled fascial flap in group B (experimental group). At 2, 4, 6, and 8 weeks, the X-ray films examination, morphology observation, and histology examination were performed; and the imaging 4-score scoring method and the bone morphometry analysis was carried out. Results All rabbits survived at the end of experiment. By X-ray film observation, group B was superior to group A in the bone texture, the space between the bone ends, the radiographic changes of material absorption and degradation, osteogenesis, diaphysis structure formation, medullary cavity recanalization. The radiographic scores of group B were significantly higher than those of group A at different time points after operation (P lt; 0.05). By morphology and histology observation, group B was superior to group A in fascial flap stability, tissue engineered bone absorption and substitution rate, external callus formation, the quantity and distribution area of new cartilage cells and mature bone cells, and bone formation such as bone trabecula construction, mature lamellar bone formation, and marrow cavity recanalization. The quantitative ratio of bone morphometry analysis in the repair area of group B were significantly larger than those of group A at different time points after operation (P lt; 0.05). Conclusion The stability of the membrane structure and the bone defect area can be improved after the internal fixation, which can accelerate bone regeneration rate of the tissue engineered bone, shorten period of bone defect repair, and improve the bone quality.
Objective To compare the effect between vascularization osteogenesis and membrane guided osteogenesis in the bone repair by the tissue engineered bone with pedicled fascial flap packing autologous red bone marrow (ARBM), so as to provide a reference for the bone defect repair in cl inic. Methods The tissue engineered bone was constructed with ARBM and the osteoinductive absorbing recombinant human materials with recombinant human bone morphogenetic protein 2. Sixty New Zealand rabbits (aged 4-5 months, weighing 2.0-2.5 kg) were randomly divided into group A (n=16), group B (n=22), and group C (n=22). The complete periosteum defect model of 1.5 cm in length was prepared in right ulnar bone, then the tissue engineered bone was implanted in the bone defect area in group A, the tissue engineered bonewith free fascial flap in group B, and the tissue engineered bone with pedicled fascial flap in group C. At 4, 8, 12, and 16 weeks, the tissue of bone defect area was harvested from 4 rabbits of each group for the general, histological, and immunohistochemical staining observations; at 8, 12, and 16 weeks, 2 rabbits of groups B and C, respectively were selected to perform ink perfusion experiment by axillary artery. Results The general observation showed that the periosteum-l ike tissues formed in the fascial flap of groups B and C, chondroid tissues formed in group B, new bone formed in group C, and the fibrous and connective tissues in group A at 4 and 8 weeks; a few porosis was seen in group A, more new bone in group B, and bone stump formation in group C at 12 and 16 weeks. Histological observation showed that there were few new blood vessels and new bone trabeculae in groups A and B, while there were large amounts of new blood vessels and mature bone trabeculae in group C at 4 and 8 weeks. There were a few new blood vessels and new bone trabeculae in group A; more blood vessels, significantly increased mature trabeculae, and the medullary cavity formation in group B; and gradually decreased blood vessels, the mature bone structure formation, and the re-opened medullary cavity in group C at 12 and 16 weeks. The immunohistochemical staining observation showed that the levels of CD105, CD34, and factor VIII were higher in group C than in groups A and B at different time points.The bone morphometry analysis showed that the trabecular volume increased gradually with time in 3 groups after operation; the trabecular volume in group C was significantly more than those in groups A and B at different time points (P lt; 0.05); and there was significant difference between groups A and B (P lt; 0.05) except the volume at 4 weeks (P gt; 0.05). The vascular image analysis showed that the vascular regenerative area ratio in group C was significantly higher than those in groups A and B at different time points (P lt; 0.05). The ink perfusion experiment showed that the osteogenic zone had sparse ink area with no obvious change in group B, while the osteogenic zone had more intensive ink area and reached the peak at 8 weeks, then decreased in group C. Conclusion The tissue engineered bone with pedicled fascial flap packing ARBM has the vascularization osteogenesis effect at early stage, but the effect disappears at late stage gradually when the membrane guided osteogenesis is main.
Objective To investigate the cl inical outcome of a surgical strategy by soft tissue expansion in treating acquired auricular defect. Methods Between January 2007 and December 2009, 136 patients with acquired auricular defect were treated with a surgical strategy by putting autoallergic costal framework after soft tissue expansion. There were 93 males and 43 females, aged 8-60 years (median, 20 years). Defects were caused by burn in 82 cases, by trauma in 47 cases, and by bite in 7 cases. Defect involved in almost the whole auricle and earlobe in 50 patients, 2/3 superior part of auricle in 35 patients, 1/3 superior part of auricle in 31 patients, 1/3 middle part of auricle in 9 patients, and 1/3 inferior part of auricle and earlobe in 11 patients. Results All the flaps had good blood supply, skin grafts all survived, and all the wounds healed by first intention after operation. All patients were followed up 6-24 months with an average of 14 months. All reconstructive auricle survived with good color, soft texture, and normal sensory function; the appearance had no enlargement and attrition, and the grafted costal cartilage framework had no malacosis, absorption, and deformation. The reconstructed ear had the same position, size, shape, and oto-cranium angle as normal ear. The curative effect was good according to ZHUANG Hongxing’s evaluation standard of auricular reconstruction. Conclusion To reconstruct auricle by soft tissue expansion is an effective method. The position of putting expander and the number of expanders are different in different patients.
Objective To compare two kinds of myofascial flap encapsulating adi pose-derived stromal cells (ADSCs) in adi pogenic efficacy in vivo, and to provide experimental basis for the efficient transplantation of free adi pose tissue. Methods ADSCs were isolated from the subcutaneous adipose tissue in the neck of 10 New Zealand rabbits (aged 3-4 months old, male and female, weighing 2.0-2.5 kg), and primary culture and subculture of ADSCs were conducted. When the cells at passage 3 covered 70%-80% of the bottom of the culture flask, BrdU (10 μg/mL) was appl ied to label the cells for 48 hours before performing immunofluorescence staining. Oil red O staining observation was conducted to thosecells 2 weeks after being induced towards adi pocyte, al izarin red staining observation was performed 3 weeks after being induced towards osteoblast, and alcian blue staining was conducted 2 weeks after being induced towards chondrocyte. Besides, after being induced towards adipocyte for 2 weeks, 1 × 107 ADSCs/piece at passage 3 labeled by BrdU was seeded into Col I (10 mm × 10 mm × 5 mm/piece) to prepare cell carrier complex. The experiment was divided into two groups: group A in which vascular pedicled dextral latissimus dorsi fascial flap was adopted to encapsulate the complex; group B in which dextral gluteus maximus fascial flap with no specific vessel pedicle was appl ied to encapsulate the complex. Rabbits in each group went through autogenous ADSCs transplant and self control. The implants were dislodged 8 weeks after operation, HE staining and immunohistochemistry staining were performed to testify cambium, the wet weight and micro vessel count of the cambium in each group were tested, immunofluorescence staining was performed to determine the origin of cambium and microvascular endothel ium. Results The nucleus of ADSCs positive for BrdU label ing showed green fluorescence under fluorescence microscope, with the positive label ing ratio of ADSCs above 90%. For ADSCs at passage 3, the formation of red l ipid droplets within cells was observed 2 weeks after being induced towards adipocyte, red calcium nodules were evident 3 weeks after being induced towards osteoblast, and highly congregated cell mass positive for alcian blue staining appeared 2 weeks after being induced towards chondrocyte. Eight weeks after operation, neogenetic blood vessel grew into scaffolds and no obvious fibreencapsulation was observed in group A, while few blood vessel grew into scaffolds in group B. The wet weight of cambium in group A and B was (0.149 5 ± 0.017 3) g and (0.095 3 ± 0.012 7) g, respectively, indicating there was a significant difference between two groups (P lt; 0.01). HE staining showed the formation of neogenetic adipose tissue and the growth of micrangium in the implant, and the degradation and absorption of scaffold. The micro vessel count of group A and B was 31.2 ± 4.5 and 19.3 ± 2.6, respectively, indicating there was a significant difference between two groups (P lt; 0.01). Eight weeks after operation, the immunofluorescence staining of cambium showed that the cell nucleus of regenerated adi pocytes and partial capillary endothel ium in groups A and B presented green fluorescence. Conclusion ADSCs encapsulated by vascular pedicled latissimus dorsi fascial flap and collagen protein scaffold complex has a higher adi pogenic efficacy in vivo than the gluteus maximus fascial flap with no specific vessel pedicle.
Objective To investigate the method and the curative effect of postauricular muscular fasciae-periosteal flap and modified unwrinkle incision in parotidectomy. Methods From January 2006 to August 2008, 28 patients with benign lesions of parotid gland were treated. There were 17 males and 11 females aged 19 to 79 years old (average 50 years old),including 20 cases of mixed tumor, 5 cases of adenolymphoma, 1 case of branchial cleft cyst, 1 case of eosinophil ic hyperplastic lymphogranuloma, and 1 case of myoepithel ioma. Tumor masses were all prominent, with the diameter of 2.4-3.8 cm and partial-tough texture. The course of disease was 3-18 months (average 9.5 months). Parotid gland and tumor mass were resected with postauricular incision hidden within the hairl ine, introcession defect (3.0 cm × 2.0 cm × 1.0 cm-3.5 cm × 2.5 cm × 1.5 cm) were repaired with simultaneouly adopting postauricular muscular fasciae-periosteal flap (4.0 cm × 3.0 cm × 1.0 cm-5.0 cm × 4.0 cm × 1.5 cm) by turning the pedicle flap 180°. Results All incision healed by first intention and no necrosis of postauricular muscular fasciae-periosteal flap occurred. All patients were followed up for 6-24 months (average 12 months). The incision was hidden within postauricular hairl ine and shape of parotid realm was good. No sal ivary fistula, facial paralysis, and earlobe numbness occurred. No Frey syndrome were found by local iodine-starch tests. Conclusion Because of hidden incision, good repair effect of region introcession deformity, and fewer postoperative compl ications, the modified parotidectomy with postauricular muscular fasciae-periosteal flap and modified unwrinkle incision is a better method in parotidectomy.
Objective To investigate the effect of repairing bone defect with tissue engineered bone seeded with the autologous red bone marrow (ARBM) and wrapped by the pedicled fascial flap and provide experimental foundation for cl inicalappl ication. Methods Thirty-two New Zealand white rabbits (male and/or female) aged 4-5 months old and weighing2.0-2.5 kg were used to make the experimental model of bilateral 2 cm defect of the long bone and the periosteum in the radius. The tissue engineered bone was prepared by seeding the ARBM obtained from the rabbits on the osteoinductive absorbing material containing BMP. The left side of the experimental model underwent the implantation of autologous tissue engineered bone serving as the control group (group A). While the right side was designed as the experimental group (group B), one 5 cm × 3 cm fascial flap pedicled on the nameless blood vessel along with its capillary network adjacent to the bone defect was prepared using microsurgical technology, and the autologous tissue engineered bone wrapped by the fascial flap was used to fill the bone defect. At 4, 8, 12, and 16 weeks after operation, X-ray exam, absorbance (A) value test, gross morphology and histology observation, morphology quantitative analysis of bone in the reparative area, vascular image analysis on the boundary area were conducted. Results X-ray films, gross morphology observation, and histology observation: group B was superior to group A in terms of the growth of blood vessel into the implant, the quantity and the speed of the bone trabecula and the cartilage tissue formation, the development of mature bone structure, the remolding of shaft structure, the reopen of marrow cavity, and the absorbance and degradation of the implant. A value: there was significant difference between two groups 8, 12, and 16 weeks after operation (P lt; 0.05), and there were significant differences among those three time points in groups A and B (P lt; 0.05). For the ratio of neonatal trabecula area to the total reparative area, there were significant differences between two groups 4, 8, 12, and 16 weeks after operation (P lt; 0.05), and there were significant differences among those four time points in group B (P lt; 0.05).For the vascular regenerative area in per unit area of the junctional zone, group B was superior to group A 4, 8, 12, and 16 weeks after operation (P lt; 0.05). Conclusion Tissue engineered bone, seeded with the ARBM and wrapped by the pedicled fascial flap, has a sound reparative effect on bone defect due to its dual role of constructing vascularization and inducing membrane guided tissue regeneration.
Objective To investigate the surgical treatment method and the curative effect of tibial nonunion with superficial peroneal vascular fascia pedicel tibiofibular periosteal flap. Methods From January 1996 to December 2008, 18 cases of tibial nonunion were treated with superficial peroneal vascular fascia pedicel tibiofibular periosteal flap, interlockingintramedullary nail ing and cancellous bone graft of distal tibial. There were 14 males and 4 females, with an average age of 32.5 years old (range, 24-67 years old). Fracture site was middle in 10 cases and distal in 8 cases. Primary injury cause included 12 cases of traffic accident and 6 cases of bruise. The tibial nonunion reasons were manual reduction and plaster immobil ization in 8 cases, small spl int immobil ization in 4 cases, intramedullary nail fixation in 2 cases (no bone graft), plate fixation in 4 cases (including 3 cases of plate fixation and free il iac bone graft). Nonunion occurred after the first surgery. The time from nonunion to operation was 8 to 16 months, with an average of 10.5 months. The size of periosteal flap was 7 cm × 5 cm and distal tibial cancellous bone graft volume was 5-10 g. Results All incision achieved heal ing by first intention after operation without flap necrosis and infection. All patients were followed up 6-36 months with an average of 20.8 months. All tibial nonunion healed 5-7 months after operation. According to Johner-Wruh scoring, the results were excellent in 14 cases, good in 3 cases, and fair in 1 case; the excellent and good rate was 94.4%. Conclusion Superficial peroneal vascular tibiofibularfascia pedicel tibiofibular periosteal flap and interlocking intramedullary nail ing can attain good results in treating nonunion of tibia and fibula because of being stable internal fixation and promoting the heal ing of nonunion.
Objective To discuss the effects of the temporoparietal fascial flap and the postauricular fascial flap as the materials to cover the postauricular-frame during the second stage operation of the total auricular reconstruction Methods From June 2005 to May 2007, the second stage elevation of the reconstructed auricle was performed at 6-10 months after the first stage total auricular reconstruction for 72 cases (left 31, right 41), 47 males and 25 females, aged 5-28 years old (12on average). According to the Nagata’s classification, 56 cases were lobule-type microtia with no external auditory canal, and the other 16 cases were concha-type microtia with external auditory canal (narrow in 9 cases). Homolateral temporoparietal fascial flap was used to cover the postauricular-frame in 29 patients (group A), and the homolateral postauricular fascial flap was used in the other 43 patients (group B). Results All the patients were followed up for 3-22 months. A total of 55 cases had excellent skin flap and fascial flap (22 in group A and 33 in group B). Darker epidermis could be seen in 15 cases (6 in group A and 9 in group B), and it healed within one month after the operation. Two cases (1 in group A and 1 in group B) suffering from partial grafted skin and fascial flap necrosis (lt; 1 cm2) healed by means of coverage of local flap transfer. All the patients’ reconstructed auriculocephal ic angles were close to the normal side. There existed scars of varying degrees at the area of skin graft in both groups: 47 cases had flat scars (19 in group A and 28 in group B); 18 cases had hyperplastic scars (7 in group A and 11 in group B); and 7 cases had severe scars with the auriculocephal ic angles draw-off (3 in group A and 4 in group B). Furthermore, there were obvious scars in temporal region and severe hair thinning at the donor site in group A, but there were no such conditions in group B. At 6 months of follow-up, reduction of the auriculocephal ic angle occurred in 3 cases of group A and obvious in 5 cases of group B (gt; 0.5 cm). Conclusion Both the temporoparietal fascial flap and the postauricular fascial flap can be appl ied to cover the postauricular-framework in the second stage reconstructed ear elevation, with superiority of the latter over the former.
Objective To evaluate a modified anterolateral thigh fascial flap designed for the treatment of the soft tissue defects in the forearmsand hands. Methods From September 2000 to December 2003, a modified anterolateral thigh fascial flap combined with the intermediate split thickness skin graft was applied to the treatment of 13 patients with the soft tissue defects in the forearms or the hands. There were 8 males and 5 females, aged 19-43 years (average, 27.6 years). Three patients had a mangled injury, 4 had a belt injury, and 6 had a crush injury; 6 patients had their tissue defects on the palm side of the forearm, 6 had their tissue defects on the dorsal side of thehand, and 1 had the defect in the index finger (dorsal side of the hand). The tissue defects ranged in size from 17.5 cm×7.7 cm to 4.6 cm×3.4 cm.In addition, 4 of the patients had an accompanying fracture in the forearm or the hand,and the remaining 9 had an extenor tendon injury. All the patients underwent emergency debridement and reposition with an internal fixation for the fracture; 3-5 days after the repair of the injured nerves, muscle tendons and blood vessels, the tissue defects were repaired with the anterolateral thigh fascial flap combined with the intermediate split thickness skin graft. Results No vascular crisis developed after operation. All the flaps survived except one flap that developed a parial skin necrosis (2.0 cm ×1.0 cm) in the hand, but the skin survived after another skingrafting. The follow-up for 3-12 months revealed that all the flaps and skin grafts had a good appearance with no contracture of the skin. According to the evaluation criteria for the upper limbs recommended by the Hand Society of Chinese Medical Association, 9 patients had an excellent result, 2 had a good result, 1 had a fair result, and 1 had a poor result, with a good/excellence rate of 85%. Conclusion The modified anterolateral thigh fascial flap combined with the skin graft is one of the best methods for the treatment of the soft tissue defects in the forearms and the hands. This method has advantages of no requirement for a further flap reconstruction, no skin scar or contracture in the future, easy management for the donor site, and less wound formation.