Objective To observe the plastic changes of sensory nerve in terms of structure and function when targetorgan changed through making the rat model of nerve regeneration by anastomosing the proximal end of sensory nerve and the distal end of motor nerve. Methods Thirty adult SD rats (male or female), weighing 200-250 g, were randomized into three groups (n=10 per group). The left upper l imb of the each rat was used as the experimental side, while the right upper l imb as the control side. In group A, the medial antebrachial cutaneous nerve was cut 5 mm away from its origin and its proximal end was anastomozed end-to-end to the distal end of musculocutaneous nerve. In group B, the musculocutaneous nerve was cut 5 mm away from its nerve entry point and the proximal end of medial antebrachial cutaneous nerve were anastomozed end-to-end to the distal end of musculocutaneous nerve. In group C, medial antebrachial cutaneous nerve and musculocutaneous nerve were cut, without further anastomosis. Twenty-four weeks after operation, the general condition and the motion of the elbow joint of rats, the wet weight and muscle fiber cross-section area of the biceps brachii as well as the latent period and the ampl itude of the evoked potential were observed and the acetylchol inesterase (AchE) staining of nerve of proximal end of anastomosis was conducted. Results All the rats survived for 24 weeks with good general condition and without wound infection. The rats in groups A, B and C were lost the active flexion of left elbow joint after operation. The rats in groups A and B got recovered to some degree at 24 weeks. The behavioral evaluation showed that there were 7 l imbs in group A and 5 l imbs in group B scoredas 4-5 points, there was a significant difference when compared with group C (P lt; 0.05), but there was no significant difference between group A and group B (P gt; 0.05). Group A and group B were superior to group C in terms of the wet weight and the muscle fiber cross-section area of the biceps brachii (P lt; 0.05), but no significant difference between group A and group B was detected (P gt; 0.05). The evoked potential of the biceps brachii and motor nerve fibers in proximal end of anastomosis could be detected in both group A and group B. But there was no significant difference between group A and group B with respects of function recovery of elbow joint, the latent period and the ampl itude of the evoked potential of the biceps brachii and the quantity of motor nerve fiber in proximal end of anastomosis (P gt; 0.05). Conclusion The change of target organ leads to the sensory nerve plasticity structurally and functionally, which may provide a new approach for peripheral nerve repair.
Objective To investigate the application of arm medial fascio-cutaneous flap pedicled with cutaneous nerve and nutrient vessel. Methods From February 1999 to December 2004, 18 cases of skin and soft tissue defect in axillary region, elbow and forearm were treated with arm medial fascio-cutaneous flap pedicled with cutaneous nerve and nutrient vessel. Arm medial fascio-cutaneous flap was directly transferred in 3 cases, adversely transferred in 15 cases. The flap area was 4.5 cm×8.5 cm. Results Vein circulation crisis was observed in 3 cases. Of the3 cases, 1 was necrosis and the other 2 by decompressing small vein were saved.The rest 15 cases survived.The period of follow-up was 3 to 30 months. Flap was satisfactory in appearance and function. Conclusion Arm medial fascio-cutaneous flap pedicled withcutaneous nerve and nutrient vessels can be directly or adversely transferred to repair adjacent soft tissue defect.
Objective To explore the cl inical outcomes of repairing l imb wound with distal based neurocutaneous flap. Methods From June 2003 to June 2009, 187 cases with wounds in the hand, foot, and distal leg were treated. There were127 males and 60 females aged 20-70 years old (average 37.5 years old). The wound was caused by traffic accident in 130 cases, crush injury in 38 cases, machinery accident in 16 cases, and explosion injury in 3 cases. Among them, the soft tissue defect was in the dorsal and palmar aspects of the hand in 35 cases, the distal leg in 50 cases, the dorsal aspect of foot in 40 cases, the region around ankle in 27 cases, the tendon area in 11 cases, the medial side of foot in 4 cases, the heel and sole of foot in 5 cases, and the forefoot area in 15 cases. The size of skin soft tissue defect was 5.0 cm × 3.0 cm-17.5 cm × 10.0 cm. Four cases suffered from nonunion of heel and 15 cases suffered from tibia defect (3-7 cm). The course of disease was 3 days-8 years. During operation, 35 cases with wound in the hand were treated with three types of lower rotation point of forearm neurocutaneous flaps with rotation points 0-3 cm above the wrist joint, 66 cases were treated with distal based saphenous nerve and saphenous vein neurovascular flaps, muscle flaps and bone flaps with rotation points 2-5 cm above the medial malleolus, and 86 cases were treated with sural and saphenous flaps, muscle flaps and bone flaps with rotation points 1-5 cm above the external malleolus. The flap was 5 cm × 3 cm-17 cm × 15 cm in size, the muscle flap was 5 cm × 3 cm × 1 cm-10 cm × 6 cm × 2 cm in size, the fibula flap was 4.0 cm × 2.5 cm-10.0 cm × 8.0 cm in size. The l igation of the superficial veins was performed below the rotation point of the flap in 163 cases, and the cutaneous nerve ending anastomosis was performed in 22 cases. The donor site was repaired byspl it thickness skin grafting from the inner side of the thigh. Results Various degree of skin flap swell ing occurred, and the swell ing extent in the patients receiving the superficial vein l igation was obvious less than that of patients with no l igation. At 4-7 days after operation, 6 cases had necrosis at the edge of flaps and 6 cases had bl ister, all of them healed after changing dress. The rest skin flaps and skin grafting in the donor site survived uneventfully, and the incision healed by first intention. All the patients were followed up for 2 months to 3 years. The appearance of the flap was satisfactory, the hand function and the foot function of walking and weight-bearing recovered. The two point discrimination of the patients 1 year after cutaneous nerve ending anastomosis was 8-12 mm. The grafted fibula in the patients with bone defect reached union 8-10 months after operation. The appearance and the movement of the donor site were normal. Conclusion The new type distal based neurocutaneous flap has such advantages as simple operative procedure, less invasion, high survival rate, and recovery of the sensory function of the hand and the foot. It is suitable to repair the tissue defect in the hand, the foot, and the distal leg.
Objective To investigate the surgical methods and cl inical results of reconstructing soft tissue defects in distal dorsal is pedis with distally based medial dorsal neurocutaneous flap on foot. Methods From January 2004 to July 2007, 11 cases of soft tissue defects in distal dorsal is pedis were treated with the distally based medial dorsal neurocutaneousflap on foot, including 8 males and 3 females aged 18-55 years. Nine cases were caused by crash and 2 cases were caused by traffic accident. There were 4 cases of tendon exposure and skin defects in the distal dorsal is pedis, 6 cases of bone exposure and skin defects in and adjacent to the first metatarsal head and 1 case of bone exposure and skin defects in the distal dorsal is pedis due to the third and fourth toe damage. The area of defects ranged from 3 cm × 3 cm to 7 cm × 5 cm. Distally based medial dorsal neurocutaneous flaps on foot were incised to repair the soft tissue defects and the size of the flaps ranged from 4 cm × 4 cm to 8 cm × 6 cm. Thickness skin graft was appl ied to repair donor site. Results All the flaps survived and all wounds healed by first intention. Skin graft in donor site survived completely in 10 cases and survived partly in 1 cases (heal ing was achieved after the flap above lateral malleolus was used to repair). All cases were followed up for 6 months-1 year. The color, texture and thickness of the flaps were similar to those of recipient site. All patients returned to their normal weight-bearing walking. No skin ulceration in flaps and donor site was observed. Conclusion The operative technique of the distally based medial dorsal neurocutaneous flap on foot is simple, convenient and safe. The distally based flap is effective in repairing soft tissue defects of middle and small sized skin and soft tissue defects in distal dorsal is pedis.
Objective To study and compare the effect of end-to-end and end-to-side neurorrhaphy between the reci pient’s musculocutaneous nerve and the donor’s ulnar nerve, and to observe the regeneration of peri pheral nerve and muscle refection. Methods Sixty male SD rats (weighing 200-250 g) were randomized into 2 groups (n=30 per group), and made the musculocutaneous nerve injury model. In group A, the donor’s nerve was transected for end-to-end neurorrhaphy.In group B, an epineurial window was exposed and the distal end of the muscle branch of musculocutaneous nerve was sutured to the side of the ulnar nerve. Electromyography was performed, biceps wet weight ratio, muscle fiber cross-sectional area, and count of myel inated nerve fiber (CMF) were measured at 4 and 12 weeks postoperatively. The behavior changes of the rats were observed. Results At 4 weeks, the nerve conduction velocity (NCV) and the latency ampl itude (AMP) of group A were significantly higher than those of group B (P lt; 0.05); at 12 weeks, there was no significant difference in the NCV and AMP between groups A and B (P gt; 0.05). At 4 and 8 weeks, there was no significant difference in biceps wet weight ratio and muscle fiber cross-sectional area between groups A and B (P gt; 0.05). At 4 weeks, the CMF was 230.15 ± 60.25 in group A and 160.73 ± 48.77 in group B, showing significant difference (P lt; 0.05); at 12 weeks, it was 380.26 ± 10.01 in group A and 355.63 ± 28.51 in group B, showing no significant difference (P gt; 0.05). Conclusion Both end-to-end and end-to-side neurorrhaphy have consistent long-term effect in repair of brachial plexus upper trunk injury.
Objective To provide the anatomical basis for posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator. Methods A total of 30 embalmed lower limbs of adult cadavers perfused with red latex were dissected and measured to observe the course and distribution of posterior femoral cutaneous nerve (PFCN), and the anastomoses between direct popliteal artery perforator and nutrient vessels of PFCN. Mimic operation was performed on 1 side of fresh specimen. Results PFCN started from the midpoint of the inferior gluteus maximus edge, and went down along the middle line of posterior thigh region, and the final trunk of PFCN accompanied with small saphenous vein down to the middle line of lower leg. The diameters of PFCN was (3.0 ± 0.6) mm at the inferior gluteus maximus edge, and was (2.0 ± 0.7) mm at the superior fossa poplitea. The nutrient vessels of PFCN were multi-segmental and polyphyletic. The direct popliteal artery perforator which started from popliteal artery directly was constant pierced into deep fascia about 7-11 cm above the knee joint, and its original diameter was (0.8 ± 0.2) mm. The direct popliteal artery perforator had 1-2 accompanying veins, and this perforator artery was the main nutrient vessel of the inferior segment of PFCN. The direct popliteal artery perforator gave off 5-8 small vessels which anastomosed with the 1st-3rd perforator of deep femoral artery, the obturator artery perforator, and the lateral femoral circumflex artery perforators. Then these nutrient vessels formed vascular plexus along PFCN in the middle line of posterior region of thigh. Mimic operation showed that the posterior femoral neurocutaneous vascular flap pedicled with direct poplitea artery perforator could be formed successfully. Conclusion The posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator has constant blood supply and can be easily formed to repair defects around knee joint.