OBJECTIVE: To explore the clinical result of velopharyngeal cerclage in repairing velopharyngeal incompetence of postoperative cleft palate patients. METHODS: From 1987 to 2000, 25 cases of velopharyngeal incompetence due to postoperative cleft palate were given the velopharyngeal cerclage. The mucosa flap of palate was pushed back, the autogenous free grafts of denervated skeletal muscle were selectively used for velopharyngeal cerclage. All the patients were followed up for 2 and a half years on average. RESULTS: All the patients achieved good results with velopharyngeal competence and good articulation. The patients’ sound of voices was clear. CONCLUSION: This method can be used to repair velopharyngeal incompetence of postoperative cleft palate patients; the operation is simple and the results are satisfactory.
Objective To introduce a new method for correction of deep nasolabial fold. Methods From May 1998 to May 2002, 20 patients( aging 32-48 years, female) with deep nasolabial fold were treated with the buried guiding suture appliance and method through oral incision. Results All patients recovered without complications , the scar is minimal. Six patients were followed up 6 to 12 months, stable and permanent result was achieved. Conclusion This method is simple and reliable for correction of nasolabial fold.
Objective To investigate a method of repairing hypospadias by combining buccal mucosal graft with scrotal flap and its therapeutic effect. Methods From March 2002 to December 2007, 42 patients with hypospadias underwent primary urethral reconstruction using buccal mucosal graft and scrotal flap. The patients ranged in age from 18 months to 18 years. There were 21 cases of penoscrotal type, 12 cases of scrotal type and 9 cases of perineal type. Among them,8 cases were at initial operation, and 34 cases suffered from the failure of hypospadias repair 6-19 months (average 10 months) after initial operation. During operation, the defect of urethra was 3-7 cm (average 4.2 cm) when the penis was straightened; the buccal mucosa (3.0 cm × 1.2 cm-7.0 cm × 1.5 cm) was transplanted to the tunica albuginea in the ventral aspect of the penis, and was paired with the scrotal flap (3.0 cm × 1.5 cm-7.0 cm × 1.5 cm) to repair urethra. Results The incision of 38 cases healed by first intention, and no compl ication occurred. At 7 days after operation, 4 cases had urinary fistula at either coronary sulcus or anastomotic stoma, one of which spontaneously closed 2 months after operation and the rest 3 recovered by repairing urinary fistula 6 months after operation. All patients were followed for 3-48 months (average 18 months). Urination was smooth, the reconstructed urethral opening was at the tip of glans peins without retraction and with apperance similar to the normal urethral opening. The appearance of penis and scrotum was satisfying, and the penis was straightened completely. Conclusion Combined buccal mucosal graft and scrotal flap, with considerable tissue for uretha tract reconstruction and low incidence rate of urethral stricture, is one of the effective methods to repair hypospadias.
Objective To investigate the effects of botulinum toxin type A (BTXA) on the excessive expansion speed and blood supply of myocutaneous flap. Methods Seven adult Guizhou minipigs of clean grade were included, female or male and weighing 16-20 kg. The 2.4 mL BTXA solution (96 U) was injected in cutaneous muscle (24 points) of one side as experimental group (n=7), the 2.4 mL saline in the other side as control group (n=7). Two expanders (200mL) were implanted beneath the cutaneous muscle on the bilateral flank of each pig symmertrically at 3 days after injection. One week later, the expanders were filled with saline every 4 days with an intracapsular pressure of 11.97 kPa, and accumulative total amounted to 400 mL for 3 weeks in control group and 5 weeks in experimental group. Then the expanders were taken out; the myocutaneous flaps formed and were sutured in situ. The myocutaneous flaps were cut for histological examination and capillary count. The expansion speed of the myocutaneous flap were recorded. The blood supply of the myocutaneous flap were observed by infrared thermography at 1 week after implantation expanders, before removing the expanders, and at 5 days after myocutaneous flap suture in situ. Results All the animals survived to the end of the experiment. The total expansion time was (54.0 ± 3.1) days in experimental group and (67.0 ± 3.9) days in control group, showing significant difference (t= —8.107, P=0.000). All myocutaneous flaps survived after being sutured in situ. Infrared thermograhy revealed that the temperature of the distal myocutaneous flap in experimental group was significantly higher than that in control group at 1 week after implantation of expanders (P lt; 0.05); at 5 days after myocutaneous flap suture in situ, the temperature of the central flap in experimental group was significantly higher than that in control group (P lt; 0.05); and there was no significant difference between 2 groups at the other time points (P gt; 0.05). The histological observation showed that the blood vessel density of the dermal layer and tissue between the capsule and the muscle layer in experimental group was significantly higher than those in control group (P lt; 0.05). Conclusion When excessive expansion is performed, BTXA can accelerate the expansion rate and improve the blood supply of expanded myocutaneous flaps.
Objective To investigate the effect of scrotal septum vascular pedicle flap with two wing-l ike spl itthickness skin graft in reconstructing urethra in patients with hypospadias and in reducing the compl ications. Methods From January 2007 to March 2008, 30 cases of hypospadias were treated, with a median age of 10 years (2-20 years). There were 13 cases of proximal shaft type, 12 cases of penoscrotal type and 5 cases of scrotal type. There were 8 cases with operation history. The flap size ranged from 4.0 cm × 0.8 cm to 9.0 cm × 1.0 cm and 5 mm with two wing-l ike spl it-thickness skin graft.When the downward curvature corrected, length of the flap could be determined by the length of the urethra that neededto be reconstructed. Results All flaps survived. The incision healed by first intention in all patients except one whose incision healed after change dressing because of frequent erection. Incision at donor site healed well. Eighteen patients were followed up for 6-12 months, including 8 with second operation history. The reconstructed urethras were unobstructed and no urethrostenosis or urinary fistula happened. Conclusion This is an improved technique of the scrotal septum flap in urethra reconstruction. It takes advantages of both flap and spl it-thickness skin graft in reconstructing urethra and avoides the disadvantages of a single tissue. It is a good choice for treating hypospadias whose urinary meatus locates neighborly to penoscrotal junctional zone.
Objective To investigate the effect of vaginal reconstruction with autologous buccal micro-mucosa graft. Methods From March 2007 and April 2008, 10 patients with absence of vagina were treated, aged 18-31 years (mean 26 years). Nine of them were congenital absence of vagina, and the remaining one was vaginal stenosis after vaginal reconstruction.They all exhibited normal secondary sexual characteristics, normal hormonal levels and 46, XX karyotype. Their abdominal ultrasounography revealed the normal ovaries and tubes but absence of the uterus or small rudimentary horns. However the one with vaginal stenosis had normal uterus. The buccal mucosa graft was minced into 0.5 mm in size and was transplanted to the cavity which was dissected between the bladder and the rectum. Results The operation was performed successfully in all cases. The operative time was about 1-2 hours and operative blood loss was 80-100 mL. Postoperative compl ication occurred in only one case for vaginal bleeding. The patient recovered and the wound healed well after immediate management. The others healed primarily without any compl ications. All cases were followed up for 4-16 months. The depth of neovagina which was formed was 6-10 cm and the width was about two fingers. The l ining was pink-colored and smooth, and was confirmed as nonkeratizing squamous stratified mucosa by histopathological examination. The donor sites healed uneventfully with no change in mouth opening. The perineal area was not disturbed. Four patients were married and satisfied with their sexual l ife without pain and bleeding. Conclusion Vaginal reconstruction with autologous buccal micro-mucosa graft is an easy, minimally invasive and useful method.
ObjectiveTo evaluate the effectiveness of acellular dermal matrix (ADM) with autologous buccal micro mucosa and micro skin graft in vaginoplasty. MethodsA retrospective analysis was made on the clinical data of 67 patients with vaginal agenesis treated between July 2006 and June 2013. ADM and mixed particles were used in 20 cases (ADM group) and mixed particles graft in 47 cases (control group) in vaginoplasty. There was no significant difference in age between 2 groups (t=0.233, P=0.816). The depth, diameter, and volume of neovagina, epithelization time, stent needing time, and female sexual function index (FSFI) score were compared between 2 groups. ResultsThere was no significant difference in operation time and amount of bleeding between 2 groups (t=-1.922, P=0.059; t=0.398, P=0.692). The patients were followed up 11-38 months (mean, 16.08 months). Fifteen cases in ADM group and 29 cases in control group had sexual life after operation. Bleeding after operation occurred in 6 cases (2 in ADM group and 4 in control group). No stenosis was observed. Difference in epithelization time was not statistically significant (t=-1.938, P=0.057). However, the stent needing time of ADM group was significantly shorter than that of control group (t=7.020, P=0.000). The neovagina was ideal in wetness degree, smoothness, flexibility, and hairlessness during follow-up. The depth, diameter, and volume of vagina had no significant difference between 2 groups (P>0.05) at last follow-up, which were close to normal vagina. The other patients had normal sexual function except 1 patient whose FSFI score was less than 23; no statistically significant difference was found in FSFI score between 2 groups (P>0.05). ConclusionOn the basis of mixed particles grafting, the ADM could improve trestle structure for resisting contracture. The effectiveness is better than merely mixed particles graft. The procedure has satisfactory anatomical and functional results.