ObjectiveTo explore the advantages and disadvantages of preoperative biliary drainage, the timing of preoperative biliary drainage, and the characteristics of various drainage methods for resectable hilar cholangiocarcinoma.MethodsBy reviewing relevant literatures at home and abroad in the past 20 years, the controversies related to the preoperative biliary drainage, surgical biliary drainage, and various drainage methods for resectable hilar cholangiocarcinoma were reviewed.ResultsThere is still a great deal of controversy about whether preoperative bile duct drainage is required for resectable hilar cholangiocarcinoma routinely, but there is a consensus on the timing of preoperative biliary drainage, and various drainage methods have their own characteristics.ConclusionsThe main treatment for hilar cholangiocarcinoma is radical surgical resection, but cholestasis is often caused by malignant biliary obstruction, which makes it difficult to manage perioperatively. A large number of prospective studies are needed to provide more evidence for the need for routine preoperative biliary drainage in patients with hilar cholangiocarcinoma who can undergo resection.
OBJECTIVE: To build the trestle of tissue engineering for skin with the collagen. METHODS: The collagen was obtained from the baby cattle hide pretreated by Na2S and elastinase and Protease M, then the collagen was dissolved in 0.5 mol/L acetic acid solution. The collagen was treated with Protease N to minimize its immunogenicity. The resulting collagen could be used to build the trestle of tissue engineering for skin because of good biocompatibility. The collagen molecular weight and structure were analyzed by SDS-PAGE. The bioactivity of trestle was tested in the experiment of the mice wound healing and the cell implantation. RESULTS: The SDS-PAGE result of the collagen treated by Protease M showed the typical spectrum of type I collagen. The built trestle was a collagen sponge matrix in which micropore size was 50-200 microns. It could accelerate wound healing and the implanted fibroblasts could proliferate well. CONCLUSION: The collagen treated by Protease N can get good biocompatibilily and is suitable for building the trestles of tissue engineering for skin with good bioactivity.
Objective To investigate the method and clinical effect of free iliac flap grafting in repairing the tibia traumatic osteomyelitis complicated withboneskin defect. Methods From June 2001 to February 2006，28 patients with tibia traumatic osteomyelitis complicated with boneskin defect were treated with free iliac flap grafting at stageⅠ. There were 18 males and 10 females, with an average of 32.5 years(1868 years). There were traffic injury in 11 cases, bruise in 6 cases, explosive injury in 5 cases, machinery injury in 4 cases, and falling injury in 2 cases. The disease courses of patients were 1-6 months. All patients had been treated by 26 operations. The wounds located at the mid and upper tibia in 13 cases, and the inferior tibia in 15 cases. The length of free iliac was0.5-6.0 cm and the size of the flap ranged from 4.5 cm×3.5 cm to 28.0 cm×16.0 cm.The external fixation were applied in 18 cases, and steel plate were applied in 10 cases. The donor sites were sutured directly. Results All of the flaps survived completely. The wounds healed by first intention in 26 cases and by second intention in 2 cases. The donorsites healed by first intention. Twentyeight patients were followed up for 6 to 56 months(mean, 30 months).The appearances of the flaps were satisfactory and the colour was similar to recipient site. All grafted bone united 2-14 months (mean，4.6 months) after operation according to X-ray examination. In 20 patients who did not achieved union before operation, fracture healed 2 to 6 months after operation(mean, 3.2 months). Osteomyelitis recurred 12 months after operation in 2 cases and healed by nidus clearing. Conclusion Free iliac flap which used to repair tibia traumatic osteomyelitis complicated with boneskin defect, can repair the defect at stageⅠand enhance the antiinfectious ability. It isone of appropriate and effective clinical methods.
ObjectiveTo investigate the feasibil ity and effectiveness of using scar spl it thickness skin grafts combined with acellular allogeneic dermis in the treatment of large deep Ⅱ degree burn scar. MethodsBetween January 2013 and December 2013, 20 cases of large deep Ⅱ degree burn scar undergoing plastic operation were enrolled. There were 14 males and 6 females, aged 4 to 60 years (mean, 40 years). Burn reasons included hydrothermal burns in 10 cases, flame burns in 9 cases, and lime burns in 1 case. The burn area accounted for 70% to 96% total body surface area (TBSA) with an average of 79% TBSA. The time from wound healing to scar repair was 3 months to 2 years (mean, 7 months). Based on self-control, 0.7 mm scar spl it thickness skin graft was used to repair the wound at the right side of joints after scar resection (control group, n=35), 0.5 mm scar spl it thickness skin graft combined with acellular allogeneic dermis at the left side of joints (trial group, n=30). Difference was not statistically significant in the scar sites between 2 groups (Z=-1.152, P=0.249). After grafting, negative pressure drainage was given for 10 days; plaster was used for immobilization till wound heal ing; and all patients underwent regular rehabil itation exercises. ResultsNo significant difference was found in wound heal ing, infection, and healing time between 2 groups (P>0.05). All patients were followed up for 6 months. According to the Vancouver Scar Scale (VSS), the score was 5.23±1.41 in trial group and was 10.17±2.26 in control group, showing significant difference (t=8.925, P=0.000). Referring to Activities of Daily Living (ADL) grading standards to assess joint function, the results were excellent in 8 cases, good in 20 cases, fair in 1 case, and poor in 1 case in trial group; the results were excellent in 3 cases, good in 5 cases, fair in 22 cases, and poor in 5 cases in control group; and difference was statistically significant (Z=-4.894, P=0.000). ConclusionA combination of scar spl it thickness skin graft and acellular allogeneic dermis in the treatment of large deep Ⅱ degree burn scar is feasible and can become one of solution to the problem of skin source tension.
From jan.1984 through dec.1991,65 cases of hand skin defects were primarily repaired by podicled groin flap. Four of the 65 cases had skin defects on both sides of the palms and dorsal aspot of the hands which were treated by the Y-shaped hypogastric groin flap .Five easec had thumb loss in which the lxdicled groin tubed flap was used to reconstruct the thumb.The time of division of the pedicles ranged from 14 to 28 days(averaged 16 days).All flape survived after division of the podicl...
In order to correct the dysfunction of head and neck with scar contracture, since 1980, sixty-two cases were undertaken the operation by using local skin flap to repair the soft tissue defect after scar resection. The skin flaps included pedicled delto-thoracic skin flap in 26 cases, cervico-thoracic skin flaps in 25 cases, cervico-shoulder flaps in 6 cases, pedicled vascularized extralong delto-thoracic skin flap in 4 cases and free parascapular flap in 1 case. Sixty cases had total survival of the flaps and 2 flaps had partial necrosis. After 1 to 10 years follow-up, the appearance and function of neck were excellent. It was suggested that grafting local skin flap was a good method to treat cicatricial deformity of neck especially using the skin flap with pedicle and vascular bundle.
OBJECTIVE To investigate the mechanism of necrosis of avulsion injured skin flap. METHODS Six swine were used. An avulsed skin flap and traditional island flap were made on each hind leg of the swine respectively, and the latter was used as control. Then the microvascular casting of each flap was made routinely immediately following the injury and 72 hours later, and the vascular casting were observed under electron microscopic scanning. RESULTS There were three characteristic changes in the avulsed skin flap: tearing of blood vessels, formation of complete thrombosis and incomplete thrombosis. If these changes were excessive in the avulsed flap, then the necrosis was the result, otherwise, the flap survived. CONCLUSION The necrosis of avulsed flap was related to the type and extent of the damage of microvascular endothelial structure. So the degree of endothelial damage was the keypoint in the viability of avulsed flap.
ObjectiveTo investigate the expression of caspase-3 and Toll-like receptor 4 (TLR4) in the incised rat skin healing process and its relationship with the wound time and to provide an experimental evidence for the prediction of injury time. MethodsAfter the rat incised wound model was established, hematoxylin-eosin dyeing technology and immunohistochemical staining technique were used to observe the expression of caspase-3 and TLR4. Then Image Pro Plus Image analysis software and SPSS statistical analysis software were used to deal with the experimental results. ResultsCaspase-3- and TLR4-positive cells were detected in epidermis, hair follicle and sebaceous gland cells in the control skin. The expression of caspase-3 and TLR4 of the ante mortem groups were significantly different compared with the control group except the 0 h group (P<0.05). Caspase-3- and TLR4-positive cells were detected in neutrophils around the hair follicle half an hour later. Caspase-3- and TLR4-positive cell rate increased with the infiltration of inflammatory cells. Caspase-3- and TLR4-positive cell rate reached the maximum on the 3 rd day, and then it began to decrease, and they were mainly expressed in fibroblasts and mononuclear macrophages. Caspase-3- and TLR4-positive cells were mainly expressed in fibroblasts on the 10th day. There was no significant differences between the postmortem injury groups and the normal control groups (P>0.05). ConclusionCaspase-3- and TLR4-positive cell rate is time dependent and stable in 25℃ temperature environment which makes it possible to determine the time of injury.
In this study, 8 pigs, weight ranged from 25 to 30kg, were used. Island skin flaps with the deep circumflex iliac artery were designed as pedicle on both buttocks. In the distal half of the island skin flap, which had been made on the right buttock, a subdermal vascular network island skin flap was made by preserving the subdermal vascular network. Blood supply between the two types of skin flap was compared by skin temperature, laser Doppler, fluorescent stain, histological examination, ink perfusion microangiography and transparent specimen technique. The observation showed thatthe blood supply of the subdermal vascular network island skin flap was decreased prominently in comparison with that of the conventional island skin flap. The subdermal vascular network skin flap was actually a combination of axial pattern skin flap with randomized skin flap.
OBJECTIVE: To explore a new surgical approach to repair skin and soft tissue defect of hands. METHODS: Based on the anatomical study of the origin, course, branch, distribution, and anastomosis of the posterior interosseous artery and its recurrent branches in 40 upper limbs of cadavers, the posterior forearm serial flap, pedicled with the posterior interosseous artery and its recurrent branches, was designed and applied clinically in 17 cases to repair the skin and soft tissue defect of hands from August 1998 to July 2000. The size of flaps ranged from 7 cm x 5 cm to 15 cm x 10 cm. All of the cases were followed up for 3 weeks to 6 months. RESULTS: The anatomy study showed that the posterior forearm serial flap had long vascular pedicle, suitable thickness and large skin area. The clinical application indicated that the flaps survived in 16 cases. But flap necrosis at the distal end, sized 2 cm x 3 cm, was observed in one case, in which the defect was repaired by delayed skin grafting, CONCLUSION: The posterior forearm serial flap pedicled with the posterior interosseous artery and its recurrent branch have the character of avoidance of sacrificing the major arteries of the extremity, longer vascular pedicle, larger area and suitable thickness. The posterior forearm serial flap is a safe and easily manipulated surgical approach to repair the skin and soft tissue defect of the hands, especially of the thumb, palm, and proximal part of the fingers.