Objective To review the latest progress in the major biological properties of adipose-derived stem cells (ADSCs) and ADSCs assisted autologous lipotransfer in breast repair and reconstruction. Methods Recent literature about ADSCs assisted autologous lipotransfer in breast repair and reconstruction was reviewed. Results ADSCs have multipotential differentiation capacity, and they could promote angiogenesis and regulate immune reactions. ADSCs assisted autologous lipotransfer can obtain satisfactory effectiveness in breast repair and reconstruction with few complications, but more studies are needed to confirm the long-term safety. Conclusion ADSCs assisted autologous lipotransfer has good effectiveness in breast repaired and reconstruction. But further clinical trials are needed to confirm the long-term safety.
Objective To review recent advance in the application and research of three-dimensional digital knee model. Methods The recent original articles about three-dimensional digital knee model were extensively reviewed and analyzed. Results The digital three-dimensional knee model can simulate the knee complex anatomical structure very well. Based on this, there are some developments of new software and techniques, and good clinical results are achieved. Conclusion With the development of computer techniques and software, the knee repair and reconstruction procedure has been improved, the operation will be more simple and its accuracy will be further improved.
Objective To construct a new composite artificial trachea and to investigate the feasibility of trachea repair and reconstruction with the new composite artificial trachea transplantation in dogs. Methods The basic skeleton of the new composite artificial trachea was polytetrafluoroethylene vascular prosthesis linked with titanium rings at both ends. Dualmesh was sutured on titanium rings. Sixteen dogs, weighing (14.9 ± 2.0) kg, female or male, were selected. The 5 cm cervical trachea was resected to prepare the cervical trachea defect model. The trachea repair and reconstruction was performed with the new composite artificial trachea. Then fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction were conducted at immediate, 1 month, and 6 months after operation. Gross observation and histological examination were conducted at 14 months to evaluate the repair and reconstruction efficacy. Results No dog died during operation of trachea reconstruction. One dog died of dyspnea at 37, 41, 55, 66, 140, and 274 days respectively because of anastomotic dehiscence and artificial trachea displacement; the other 10 dogs survived until 14 months. The fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction showed that artificial tracheas were all in good location without twisting at immediate after operation; mild stenosis occurred and anastomoses had slight granulation in 6 dogs at 1 month; severe stenosis developed and anastomosis had more granulation in 1 dog and the other dogs were well alive without anastomotic stenosis at 6 months. At 14 months, gross observation revealed that outer surface of the artificial trachea were encapsulated by fibrous connective tissue in all of 10 dogs. Histological examination showed inflammatory infiltration and hyperplasia of fibrous tissue and no epithelium growth on the inner wall of the artificial trachea. Conclusion The new composite artificial trachea can be used to repair and reconstruct defect of the trachea for a short-term. Anastomotic infection and dehiscence are major complications and problems affecting long survival.
Objective To review the recent progress of the small intestinal submucosa (SIS) in application research of tissue repair and reconstruction. Methods The domestic and international articles on the SIS were reviewed and summarized. Results As a natural extracellular matrix, SIS has outstanding biological advantages, such as good mechanical property, tissue compatibility, and lower immunogenicity. SIS has been used to repair and reconstruct various types of tissue defects in animal models and clinical application, especially in the treatment of hernia, urinary system disease, and refractory skin trauma. The development of the tissue engineering technology expands the field of SIS repair and reconstruction and promotes the intensive study of SIS. However, the long-term effect of SIS in tissue repair and reconstruction still remains to be further observation, while the cell/SIS material construction by tissue engineering technology also needs more studies. Conclusion SIS has a widely promising application future in the tissue repair and reconstruction.
Objective To investigate the effectiveness of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction combined with l imited open repair of medial collateral ligament (MCL) in recovering the stabil ity and the function of the knee. Methods Between April 2003 and October 2010, 14 patients (14 knees) with multi ple injuries of ACL, PCL, and MCL were treated. There were 10 males and 4 females with an average age of 41 years (range, 21- 71 years). Injury was caused by traffic accident in 11 cases and fall ing in 3 cases. The average time from injury to admissionwas 2 days (range, 1-4 days). Lysholm score was 17.00 ± 8.29, and the International Knee Documentation Committee (IKDC) score was 20.93 ± 8.28. The complicated injuries included dislocation of the knee joint in 9 cases and meniscus injury in 5 cases. Allogeneic tendons (2 cases) and autologous harmstring tendon (12 cases) were used to reconstruct ACL and PCL under arthroscopy, and all cases underwent limited open repair of MCL. Results All incisions healed by first intention. Numbness of the lower limb occurred in 3 cases and alleviated spontaneously. All patients were followed up 14 months on average (range, 12-18 months). The knee flexion was 120° and extension was 0° at 3 months of follow-up. After 1 year of follow-up, IKDC score and Lysholm score were 89.93 ± 6.26 and 88.93 ± 4.82, respectively, showing significant differences when compared with preoperative scores (P lt; 0.01). Conclusion For multi ple injuries of the knee ligaments, an arthroscope with limited open repair and reconstruction of the knee ligament can avoid open joint chamber, reduce postoperative articular adhesion, and encourage the joint function recovery.
Objective To review the latest researches of synthetic biodegradable polymers for bone repair and reconstruction, to predict the progress of bone substitute materials and bone tissue engineering scaffolds in future. Methods The l iterature concerning synthetic biodegradable polymers as bone substitute materials or bone tissue engineering scaffolds was collected and discussed. Results Al i phatic polyester, polyanhydride, polyurethane and poly (amino acids) were the most extensively studied synthetic biodegradable polymers as bone substitutes and the scaffolds. Each polymer was of good biological safety and biocompatibil ity, and the degradation products were nontoxic to human body. The mechanical properties and degradation rate of the polymers could be adjusted by the type or number of the monomers anddifferent synthetic methods. Therefore, the polymers with suitable mechanical strength and degradation rate could be produced according to the different requirements for bone grafting. Prel iminary studies in vivo showed their favorable capacity for bone repair. Conclusion The synthetic biodegradable polymers, especially the copolymers, composite materials and those carrying bone growth factors are expected to be the most promising and ideal biomaterials for bone repair and reconstruction.
ObjectiveTo investigate the short-term effectiveness of allogeneic bone transplantation for pelvic reconstruction of large skeletal defects after tumor resection. MethodsBetween January 2008 and November 2009, 9 patients with pelvic tumor were treated, and the clinical data were retrospectively analyzed. There were 1 male and 8 females with an average age of 36.1 years (range, 18-44 years). There were 5 cases of giant cell tumor of bone, 2 cases of chondrosarcoma, 1 case of malignant giant cell tumor of bone, and 1 case of Ewing sarcoma. According to the Enneking system for staging musculoskeletal tumors, the lesion involved ilium (region I) in 4 cases, acetabulum (region II) in 6 cases, pubis and ischium (region III) in 3 cases, and sacrum (region IV) in 1 case. The average disease duration was 6.8 months (range, 1-36 months). After accurate resection of the tumor, allograft ilium with or without acetabulum was used in 6 cases and 2 cases respectively, and allogenous bone plate in 1 case for pelvic reconstruction; total hip arthroplasty was performed in 6 cases; sacrum screw was used in 1 case. ResultsInfection of incision and abdominal distention occurred in 1 case, and was cured after debridement; primary healing of incision was obtained in the other cases, without infection, lower limb deep venous thrombosis, or dislocation. The average follow-up was 11.8 months (range, 8-15 months). The X-ray films showed breakage of plate in 1 case at 8 months after operation and partial bone resorption in 2 cases; good position of the prosthesis, plate, and transplanted bone was observed in the other cases. No local recurrence was found. At last follow-up, the average musculoskeletal tumor score (MSTS) was 23 (range, 18-29). ConclusionAllogeneic bone transplantation for pelvic reconstruction of large skeletal defects after tumor resection can achieve satisfactory short-term surgical and functional effectiveness.
ObjectiveTo explore the application of three-dimensional (3-D) printing technique in repair and reconstruction of maxillofacial bone defect. MethodsThe related literature on the recent advance in the application of 3-D printing technique for repair and reconstructing maxillofacial bone defect was reviewed and summarized in the following aspects:3-D models for teaching, preoperative planning, and practicing; surgical templates for accurate positioning during operation; individual implantable prosthetics for repair and reconstructing the maxillofacial bone defect. Results3-D printing technique is profoundly affecting the treatment level in repair and reconstruction of maxillofacial bone defect. Conclusion3-D printing technique will promote the development of the repair and reconstructing maxillofacial bone defect toward more accurate, personalized, and safer surgery.
Objective To summarize the clinical experience of vascular repair and reconstruction for treating superior vena cava syndrome (SVCS) caused by thoracic tumor. Methods Between October 2008 and June 2016, 26 patients with thoracic tumor and SVCS were admitted. There were 18 males and 8 females, aged from 27 to 70 years (mean, 45.9 years). Tumor was typed as B1-B3 thymoma in 13 cases, thymic carcinoma in 6 cases, large B-cell lymphoma in 3 cases, T lymphocytic lymphoma in 1 case, malignant teratoma in 1 case, right lung squamous cell carcinoma in 1 case, and carcinoid in 1 case. The tumor diameter ranged from 8 to 15 cm with an average of 10 cm. The patients had different degrees of neck, face, and upper extremity edema, jugular vein distention, and chest wall collateral venous filling. The superior vena cava pressure was 2.45-5.39 kPa. After excision of tumor and invading superior vena cava, 7 patients underwent superior vena cava reconstruction and 19 patients underwent artificial vascular replacement. Results There was no perioperative death, and the symptoms of superior vena cava obstruction were eliminated. Postoperative pulmonary infection, respiratory muscle weakness, and right chylothorax occurred in 4 cases, 1 case, and 1 case respectively. Twenty-four patients were followed up 2-92 months (mean, 37 months), and 2 patients failed to be followed up. At 1, 3, and 5 years, the survival rate was 83.3% (20/24), 41.7% (10/24), and 25% (6/24), respectively. In 6 patients with 5-year survival, there were 1 case of type B1 thymoma, 3 cases of type B3 thymoma, and 2 cases of large B-cell lymphoma. Conclusion For preoperative evaluation of SVCS caused by resectable thoracic tumors, vascular repair and recons-truction technique can be used to quickly and effectively relieve the clinical symptoms and improve the quality of life.
Objective To review the research progress and clinical prospect of three-dimensional spheroid culture of mesenchymal stem cells (MSCs). Methods Recent literature about three-dimensional spheroid culture of MSCs was summarized, mainly on the formation of MSCs spheroids collected by three-dimensional culture, differences between MSCs spheroids and MSCs collected by traditional two-dimensional culture, and the mechanism underlying these differences. Last, its clinical prospect was discussed. Results Compared with MSCs collected by traditional two-dimensional culture, MSCs spheroids collected by three-dimensional culture get a salient up-regulation in anti-apoptosis, multiple differentiation potential, paracrine, and anti-inflammatory effect, which may be related to the morphology and cytoskeleton organization, cell-to-cell contact and gap junctions, and the hypoxia microenvironment. The animal experiments show obvious effects in repair of refractory wounds, repair of ischemic injury, and tissue remodeling, so MSCs spheroid has broad clinical prospect. Conclusion MSCs spheroids collected by three-dimensional culture have stronger biological potential and treatment effect than MSCs collected by traditional two-dimensional culture, MSCs spheroids can be used to optimize stem cell therapy and improve its treatment effect.