OBJECTIVE: To investigate the clinical effects of the microsurgical treatment for the skin-degloving injury of the whole hand or foot. METHODS: From March 1984 to October 2001, we treated 6 cases of skin-degloving injury of the whole hand and foot. In 2 cases of skin-degloving hands, one was treated with free great omentum transplantation plus skin graft, the other with pedical abdominal S-shaped skin flap as well as mid-thick skin graft. In 4 cases of skin-degloving injury of the foot, 2 cases was repaired with free latissimus dosi musculocutaneous flap, 1 case with distall-based lateral skin flap of the leg and 1 case with free tensor fasciae latae muscle flap. The flap size ranged from 7 cm x 9 cm to 22 cm x 15 cm. One case was operated on the emergency stage, the other 5 cases on the delayed stage. The delayed time ranged from 2 to 14 days with an average of 6.6 days. RESULTS: All the flaps survived. After 1-2 year follow-up, the appearance and function of the hand and the foot were good. CONCLUSION: Microsurgery technique in repairing skin-degloving injury of the whole hand and foot can achieve good results. The keys to success are thorough debridement of the recipient area, appropriate selection of the donor site, good vascular anastomosis and active postoperative rehabilitation.
Objective To detect the operative technique and aesthetic problem of reconstruction to deformity of bilateral cleft lip． Methods From March 2003 to December 2004, 26 patients with bilateral cleft lip were treated, aged 10 months to 11 years. Of 26 patients, there were 13 bilateral complete cleft lip and palate, 9 bilateral incomplete cleft lip and 4 mixed cleft lip with unilateral complete cleft palate. The chief design principle was keeping the length of prolabium. During operation, sufficient dissociation was made in the base of the ala base and orbicularis oris muscle to reconstruct these structures．The circle suture was made for the bilateral orbicularis oris muscle. The shape of vermilion was achieved by lateral red lip muscle flap and simultaneous simple rhinoplasty was performed. Results Primary healing of the incisions was achieved in all cases. After the 10 days-3 months follow-up, the results were satisfactory in thewidth and chubbiness of the nose bottom,the shapes of nostril and Cupid’s bow were good without whistle deformity. Theapperance of upper lip was good in either dynamic or static state． Conclusion Excellent shapes and function of the nose and lip， and opportunity for twostage repair could be obtained with this method，which being believed important methods for the primary repair of bilateral cleft lip．
Objective To study the feasibility, surgical techniques, and results of submental island flaps for reconstruction of hypopharyngeal noncircumferential defects. Methods A retrospective review of the archives was performed on 16 patients（6 males, 10 females, aged 41-78 years）who suffered from hypopharyngeal cancer. From August 1998 to August 2002, the patients underwent a partial removal of the hypopharynx and reconstruction by submental island flaps. Their hypopharyngeal carcinomas belonged to squamous carcinoma. Of the 16 patients (2 in UICC clinical stage Ⅱ, 11 in Ⅲ, 3 in Ⅳ), 9 had their pathologicalorigin in the pyriform sinus, 4 in the posterior pharyngeal wall, and 3 in the postcricoid. The flap area ranged from 8.0 cm×4.5 cm to 5.0 cm×3.0 cm. Results The follow-up for 3-7 years showed that the submental island flaps healed well in all patients with a success rate of 100%. The swallowing function returned to normal 1014 days after operation without complications of salivary fistula and infection. The 3-year and 5-year survival rates were 68.8% (11/16) and 62.5% (5/8), respectively. Conclusion Submental island flaps are convenient for reconstruction of hypopharyngeal noncircumferential defects, and they are safe and reliable, too.
OBJECTIVE: To investigate the effect of soft tissue repairing at different times on the union of type III b tibial fracture. METHODS: From January 1987 to January 1999, seventy-six type III b tibial fractures were divided into 3 groups: early group(0 to 7 days), subacute group(8 to 30 days), late group(more than 30 days) according to the time of soft tissue repairing. The morbidity rates of complications such as infection, nonunion as well as the time to union were compared respectively. RESULTS: Followed up for 10 to 36 months (averaged 24 months), the infection and nonunion rates of early group were lower than that of subacute and late groups(P lt; 0.01), the average time of fracture union of early group was less than that of subacute and late groups. CONCLUSION: Early soft tissue repairing can decrease the complications and the time to union of Type III b tibial fracture obviously. The time of "early" should be limited in one week and as soon as possible.
Objective To explore the effects of bone marrow mesenchymal stem cells (BMSCs) transfected with adenovirus hepatocyte growth factor (Ad-HGF) on wound repair in diabetic rats. Methods BMSCs from male Wistar rats were isolated by density gradient centrifugation, cultured, and transfected with Ad-HGF. The multi pl icity of infection was 100. Diabetic models were establ ished in 20 female Wistar rats by diets in high fat and sugar plus intraperitoneal injection ofstreptozotocin (30 mg/kg). Then 2 full-thickness skin wounds (approximately 1.5 cm in diameter) were made on the dorsum. The rats were randomly divided into 4 groups (n=5 rats). After wounding, the 0.3 mL suspensions of BMSCs (group A), Ad- HGF (group B), BMSCs transfected with Ad-HGF (group C), and PBS (group D) were injected directly into the derma of wounds. The transverse diameter and longitudinal diameter of wound were measured at 21 days after treatment. At 7 days and 28 days after treatment, HE staining was performed to evaluate wound heal ing. The contents of hydroxyprol ine and advanced glycosylation end products (AGEs) in the wounds were measured by enzyme l inked immunosorbent assay and fluorospectrophotometer, respectively, at 3, 7, 14, and 28 days after treatment. Results At 21 days after treatment, the wounds almost healed in group C, and the transverse diameter and longitudinal diameter were 0 and (0.110 ± 0.024) cm, respectively. But the wounds healed partially in groups A, B, and D, and the transverse diameter and longitudinal diameter were (0.470 ± 0.051) cm and (0.590 ± 0.041) cm, (0.390 ± 0.042) cm and (0.480 ± 0.032) cm, and (0.700 ± 0.068) cm and (0.820 ± 0.068) cm, respectively. There were significant differences in wound heal ing between group C and groups A, B, and D (P lt; 0.05). The wound heal ing time of group C [(20.5 ± 1.9) days] was significantly shorter (P lt; 0.05) than those of groups A, B, and D [(28.3 ± 1.9), (25.9 ± 2.3), and (36.6 ± 5.1) days]. At 7 days, the HE staining showed that evident epidermis transportation, collagen formation, and leukocytes infiltration were observed in group C. At 28 days, the HE staining showed that the epidermis in group C was significantly thinner and more regular than those in other groups, and the decreased collagen and many small vessels were observed in group C. The content of hydroxyprol ine in group C was higher than those in groups A, B, and D at 7 days and 14 days (P lt; 0.05). The contents of AGEs in group C was lower than those in groups A, B, and D at 14 days and 28 days (P lt; 0.05). Conclusion Transplantation of BMSCs transfected with Ad-HGF can accelerate the wounds repair in diabetic rats.
Objective To investigate the clinical feasibility of different types of the saphenous neuro-veno-fascial cutaneous flaps. Methods From June 1996 to October 2002, 18 cases of skin defects in the knee and the lower part of the limb were treated with proximally(4 cases) or distally(11 cases) based pedicles of saphenous neuro-venofascial cutaneous flap or crossleg flap (3 cases)according to the site of defects . The sizes of the flaps ranged from 4 cm×5 cm to 9 cm×20 cm. Results The flaps survived completely in 17 cases, distal 1/5 of the flap necrosed partially in 1 case because of vein drainage disturbance. The colour and texture of flaps were excellent, the appearance and function were satisfactory after a follow up of 6-24 months.Conclusion The saphenous neuro-veno-fascial cutaneous flap is an idea flap in repairing skin defects of the knee, the leg, the ankle and the foot because it is easy to be designed and dissected and it has reliable blood supply and preserved main artery. The relationship between the septal perforating branches of the tibial posteriorartery and survival size of flap need to be investigated further.
Objective To summarize the clinical experiences of various types of the second dorsal metacarpal artery (SDMA) flap for hand reconstruction. Methods From 1988 to 2003, 139 SDMA flaps were transferred for hand injuries. The flaps were used in 5 types according to vascularization and technique in transplantation:orthograde pedicled island SDMA flaps in 37 cases (cutaneous in 24and teno-cutaneous in 13), retrograde pedicled island SDMA flaps in 25 cases(cutaneous in 19 and teno-cutaneous in 6),double pivot SDMA flaps in 36 cases(cutaneous in 28 and teno-cutaneous in 8), distal perforator branch pedicledflaps in 19cases (cutaneous in 16 and composite in 3), free SDMA flaps in 22 cases (cutaneous in 15 and composite in 7). The skin islands were 3.0 cm×1.5 cm to 6.3 cm×5.0 cm in size. Results Of the 139 flaps, 135 flaps survived completely, 3 survived partially, and1 failed in the operation because of intractable vascular spasm. Follow-up wasdone in 116 cases for 12 to 57 months. The flap had good texture and color match. The twopoint discrimination was 5 to 9 mm in 78 sensate flaps, while it was 10 to 15 mm in 38 nonsensate flaps. In 21 tenocutaneous flaps, the TAM score of range of motion was 60% to 70% of the healthy side. Conclusion The SDMA flap has a constant and reliable vessel and a thin, pliable, and good-quality skin. It is versatile in creatingcomposite flaps. It is a good flap resource for hand and finger reconstruction.
The soft-tissue-cutaneous flap adjacent to the abdominal incisional hernia was ultilized to repair huge hernia in 6 cases with success. Patients were followed up for 2y7 years without recurrence. The operative planning, the technique and the matters needing attention were introduced in details. The soft tissues and skin adjacent to hernia used for repair was easy to obtain and a simple technique. The adoption of this operation in hospitals at the grassroots level was feasible.
OBJECTIVE: To investigate the efficacy of different flaps in the treatment of skin defect of hell. METHODS: Forty-six patients with skin defect of hell were adopted in this study. There were 39 males and 7 females, 29 years old in average. Six different flaps were applied in the reconstructive operation, 14 plantaris medialis flaps, 4 flexor digitorum brevis muscle flaps, 3 abductor hallucis flaps, 7 latissimus dorsi flaps, 16 distal medialis flaps of leg pedicled with the cutaneous branch of posterior fibial artery, 2 foot dorsum flaps. RESULTS: All the flaps survived, primary healing of the wound in 45 cases and secondary healing in 1 case. Followed up for 3 months to 4 years, 43 patients obtained good flap sensation, the function of weight bearing were satisfied in 43 patients. CONCLUSION: The six different flaps should be applied according to patient’s condition individually. The sensation of flap is very important to the function of weight bearing.
In the reconstruction of the concha, standing support was necessary. From 1984 to 1996, 33 cases of aurical defects were admitted. Three standing-materials were chosen, and they included carved autogenous cartilage, heterogenous concha cartilage and steel wire work silicon-wires with silastic rubber tube. After expansion of the postauricular skin by tinsion expander, the standing-material was enveloped and total ear reconstruction or repair was performed. After followed up for average of 3.5 years, of the twenty-two cases, 16 had a satisfactory result, unsatisfied in 3 and failure in 3. It was concluded that the outcome of autogenous concha cartilage as a standing-material was good. The other two materials if used should be very carefully.