Objective To introduce the application of the scrotal flap on reconstructing partial urethra defect. Methods From March 1998 to August 2004, 31 patients with urethra defect were treated with scrotal flap. Their ages ranged from6 to 34 years. Thirty-one patients included 8 cases of congenital deformity of urethra and 23 cases of complication of urethral fistula, urethral stenosis and phallus bend after hypospadias repair. The flap widths were 1. 2. cm in child and 2.3. cm in adult. The flap lengthwas 1. -2.0 times as much as the width. Nine cases were classified as penile type, 10 cases as penoscrotal type, 7 cases as scrotal type(3 children in association withcleft scrotum) and -cases as perrineal type because of pseudohermaphroditism.Urethroplasty was given by scrotal fascia vascular net flap to reconstruct urethra defect. Results All the flaps survived, and the incision healed well. Twenty four cases achieved healing by first intention and 7 cases by second intention. And fistula occurred and healed after 2 weeks in 1 case. 27 cases were followed up 14 years, 2 cases had slight chordee, the others were satisfactivly. Conclusion Urethroplasty with scrotal fascia vascular net flap is an ideal method for the partial defect urethra.
OBJECTIVE: To study the effect of collagen/hydroxyapatite(CHA) instead of autogenous bone transplantation on repairing the mandibular defects. METHODS: Ten Chinese experimental minipigs were made 2 cm bone defects in diameter in the mandible. The experimental group was implanted CHA, while the control group was implanted autogenous bone. The basic parameters of bone dynamics were determined by bone metrology. RESULTS: There was remarkable difference between the two groups in the mean distance and mineralization apposition rate of double label bands marked by tetracycline(P lt; 0.05), while the mean osteoid seam width and mineralization lag time had no remarkable difference(P gt; 0.05). It suggested that CHA had good osteogenesis. The collagen in CHA offered the condition of bone mineralization, and the mineralization peak of experimental group was present at 4 weeks earlier than that of control group (8 weeks). CONCLUSION: CHA may be a substitute of autogenous bone transplantation in repairing the mandibular defects, and the second operation for offering the implanting bone is avoidable, therefore, CHA may be an ideal material to repair bone defects.
OBJECTIVE: To explore the methods of treatment for old achilles tendon rupture merging with skin defect. METHODS: By following up retrospectively 10 patients from February 1995 to December 2001, we analyzed the operative methods, the points for attention and the results. Gastrocnemius musculocutaneous flaps were used in 3 cases, foot lateral skin flaps in 4 cases, superior medial malleolus skin flaps in 2 cases, and sural neural skin flap in 1 case. The Achilles tendon was sutured directly in 8 patients, with Lindholm’s technique in 2 patients. RESULTS: All flaps survived and the wound healed well in 8 cases and reruptured in 2 cases. According to Yin Qing-shui’s criteria to test the efficacy, the results were excellent in 5 patients, good in 4 and poor in 1. CONCLUSION: Repairing the old Achilles tendon rupture merging with skin defect by use of microsurgery has good results and plays an important role in reducing joint contracture and stiffness, and in saving the ability to push forward and flex.
Objective To explore an improved method of reconstructing the scalp soft tissue defect with the expanded skin soft tissue and treating and preventing the related complication. Methods From October 2002 toJune 2005, 32 patients (20 males and 12 females, aged 5-48 years) underwent reconstruction of the scalp soft tissue defects with the expanded scalp soft tissue in thetwo-stage operation. In the first stage, a tissue expander (cylindrical form, 50-250 ml) was inplanted into the skin to achieve a skin soft tissue expansion. After a sufficient skin expansion (8 cm×5 cm to 25 cm×23 cm) was made by the routine water affusion for 6-16 weeks, a properly-designed skin flap was taken and transferred to reconstruct the scalp soft tissue defect in the second-stage of the operation. All the scalp defects were left after the resections of the scalp lesions, which ranged in size from 7 cm×5 cm to 20 cm×20 cm.Results After operation, all the 32 patients had their scalp defects repaired and reconstructed well.The expanded skin flaps of all the 32 patients survived except 1 patient who had a necrosis of the distal epidermis of the flap, which healed after the dressings of the wound. The hair grew well and the scars were hidden with a satisfactory appearance. Four patients developed complications (necrosis of the distal flapin 1 patient, hematoma in 1, expander exposure in 1, and wound rupture in 1).Conclusion Reconstruction of the scalp soft tissue defect with the skin soft tissue expansion is an ideal method.
Objective To discuss and evalue the effects and the advantages of pectoral is major myocutaneous flap in repair of defect caused by resection of tonsillar cancer. Methods The data were retrospectively summarized from 10 patients with recurrent tonsillar cancer after radical radiotherapy from January 1998 to December 2005, including 7 cases of squamouscell carcinoma, 2 cases of undifferentiated carcinoma, and 1 case of adenoid cystic carcinoma. There were 8 males and 2 females, aged 43-68 years with an average of 58 years. All cases were classified as stages III and IV before radiotherapy according to staging standard of oropharyngeal cancer (International Union Against Cancer, 1997). The time of relapse was 6-32 months after radiotherapy. Recurrent tonsil cancer invased tongue base, soft palate, posterior wall of pharyngeal, parapharyngeal space, and palate. Tumor size was from 4 cm × 2 cm to 8 cm × 5 cm. Seven cases were accompanied by lymph node metastasis. After carcinoma were completely resected and defects were reconstructed by pectoral is major myocutaneous flap of 7 cm × 5 cm- 12 cm × 9 cm. The donor sites were sutured directly. Results After operation, pectoral is major myocutaneous flap completely survived in 9 cases. Partial necrosis of pectoral is major myocutaneous flap was found in 1 case; after treatment, the necrotic flap remained small pharyngeal defect. Incision at donor site healed by first intention in 10 cases. All patients showed satisfactory functions of respiratory, voice, and swallowing with no compl ication. Ten patients were followed up 2 years to 5 years and 8 months. The 3-year survival rate was 66.7% (6/9), and the 5-year survival rate was 20.0% (1/5). Conclusion Pectoral is major muscle flap has a high survival rate, which is safe, rel iable, easy-to-operate, and can repair larger defect. Pectoral is major myocutaneous flap is an ideal material in repair of defect caused by resection of recurrent tonsillar carcinoma after radiotherapy.
Objective To investigate the clinical effects of repairing massive bone defects in limbs by using vascularized free fibular autograft compoundingmassive bone allografts. Methods From January 2001 to December 2003, large bone defects in 19 patients (11 men and 8 women, aging from 6 to 35 years) were repaired by vascularized free fibular transplant with a monitoringflap compounding massive deep frozen bone allografts. The length of bone defects were 12 to 25 cm (16.6 cm on average), of vascularized free fibular 15 to 28 cm (18.3 cm on average), and of massive bone allografts 11 to 24 cm (16.1 cm on average). Thelocation of massive bone defects were humerus in 1 case, femur in 9 cases and tibia in 9 cases. Results After followup of 5 to 36 onths (18.2 months on average), wounds of donor and recipient sites were healed at Ⅰstage, monitoringflaps were alive, no obvious eject reaction of massive bone allografts was observed and no complications occurred in donor limbs. The radiographic evidence showed union in 15 patients 3 months and 3 patients 8 months after operation. One case of malignant synovioma of left lower femur recurred and amputation was performed 2.5 months after surgery. Internal fixation was removed in 5 patients, and complete bone unions werefound 1 year postoperatively. No massive bone allografts was absorbed or collapsed. Conclusion With strict indication, vascularized free fibular autograft compounding massive bone allografts, as an excellent method of repairing massive bone defects in limbs, can not only accelerate bone union but also activate and changer the final results of massive bone allografts from failure.
Objective To investigate the clinical effect ofthe pectoralis major myocutaneous flap and Ti-plate system in repairing mandibular defects caused by resection of oral carcinoma.Methods From November 2001 to February 2003, 32patients with mandibular defect caused by resection of oral carcinoma were treated. Combined radical neck dissection with resection of gingival and mandible was performed on 11 patients with carcinoma of the lower gingival, combined radical neck dissection with glossectomy and mandibulectory on 13 patients with carcinoma of tongue, combined radical neck dissection with resection of floor of mouthand mandible on 4 patients with carcinoma of floor of mouth, and combined radical neck dissection with resection of cheek and mandible on 4 patients with carcinoma of buccal mucosa, respectively. The defects of mandible were associated with soft-tissue component, the sizes of defect ranged from 5.5 cm×7.6 cm to 8.2 cm×10.5 cm. The defects were reconstructed with 6 cm×7 cm to 9 cm×10 cm pectoralis major myocutaneous flaps and Tiplate system. The effect was studied retrospectively. Results Thirty-two cases were followed for 219 months; 29 cases offlaps survived and 3 cases of flaps partly necrosed (10% or less of the skin paddle). The appearance of face was satisfactory in 27 patients, and slight deformity of face was observed in 5 patients. The occluding relation and masticatory function were recovered well. Opening mouth extents ranged from 2.7 cm to 3.4 cm. No temporomandibular arthrosis relating to operation was found in all cases. Conclusion A combination of thhe pectoralis major myocut aneous flap and Ti-plate system is an ideal method for reconstruction of mandible defects associated with soft-tissue component after radical operation of oral carcinoma.
Objective To investigate the curative effects of homograft of the mesenchymal stem cells(MSCs) compbined with the medical collagen membrane of the guided tissue regeneration(MCMG) on the full thickness defects of the articular cartilage. Methods MSCs derived from New Zealand rabbits aged 3-4 months weighing 2.1-3.4 kg were cultured in vitro with a density of 5.5×108/ml and seeded onto MCMG. The MSC/MCMG complex was cultured for 48 h and transplanted into the fullthickness defects on the inboardcondyle and trochlea. Twenty-seven healthy New Zealand rabbits were randomly divided into 3 groups of 9rabbits in each. The cartilage defects in the inboard condyle and trochlea werefilled with the auto bone marrow MSCs and MCMG complex (MSCs/ MCMG) in Group A (Management A), with only MCMG in Group B (Management B)and with nothing in Group C (Management C). Three rabbits were killed at 4, 8 and 12 weeks after operation in each group, and the reparative tissue samples evaluated grossly,histologically and immunohistochemically were graded according tothe gross and histological scale. Results Four weeks after transplantation, the cartilage and subchondralbone were regenerated in Group A;for 12 weeks, the regenerated cartilage gradually thicked; 12 week after transplantation, the defect was repaired and the structures of the carticular surface and subchondral bone was in integrity.The defects in Group A were repaired by the hylinelike tissue and the defects in Groups B and C were repaired by the fibrous tissues. Glycosaminoglycan and type Ⅱcollagen in Groups A,B and C were reduced gradually.The statistical analysis on the gross at 12 weeks and the histologicalgradings at 4 weeks,8 weeks and 12 weeks showed that the inboardcondylar repairhad no significant difference compared with the rochlearepair(Pgt;0.05).Management A was significantly better than Managements B and C (Plt;0.05), and Management B was better than Management C(Plt;0.05). Conclusion Transplantation of the MSCs combined with MCMG on the full thickness defects of the articular cartilage is a promising approach to the the treatment of cartilage defects. MCMG can satisfy the demands of the scaffold for the tissue-engineered cartilage.
OBJECTIVE To explore the effect of basic fibroblast growth factor (bFGF) combined with autogenous vein graft conduit on peripheral nerve regeneration. METHODS Fifty four New Zealand rabbits were divided into three groups. The main trunk of sciatic nerve of rabbit in one side was severed and bridged by autogenous vein. 0.2 ml bFGF solution (4,000 U/ml) was intravenously injected to the vein graft conduit as group A, the same amount of saline solution as group B, and no solution injection as group C. Microscopic examination, axon video analysis and nerve conduct velocity were performed at the 10th, 30th, and 100th day after operation. RESULTS The nerve fibers were grown into vein graft conduit in all groups at 30th after operation, they were more and regular in group A than that of group B and C, and the axon regeneration rate in group A was more than that of group B and C. CONCLUSION bFGF combined with autogenous vein graft conduit can markedly promote nerve regeneration.
Objective To investigate the method and effectiveness of perforator flaps in repairing soft tissue defects of extremities. Methods Between June 2002 and December 2009, 81 patients with soft tissue defect of extremities were treated. There were 69 males and 12 females with an average age of 54 years (range, 13-75 years). Defect causes were injury in 35 cases (the disease duration ranged from 1 hour to 45 days), tumor resection in 19 cases, and scar resection in 27 cases. The defect located at limb and foot in 56 cases, forearm and hand in 25 cases. The defect size ranged from 3 cm × 3 cm to 23 cm × 18 cm. The perforator flaps included the peroneal artery perforator flap in 26 cases, the radial artery perforator flap in 18 cases, the medial plantar artery perforator flap in 18 cases, and the lateral circumflex femoral artery perforator flap in 19 cases. The flap size ranged from 4 cm × 3 cm to 25 cm × 18 cm. The donor site was sutured directly or repaired by free skin graft. Results Partial necrosis of the flaps occurred in 4 cases at 3-7 days after operation, then the flap survived after expectant treatment. The other flaps and free skin grafts survived successfully, and the incisions healed by first intention. All patients were followed up 1 to 16 months with an average of 9 months. The appearance, texture, and colour of the flaps were similar to those of the donor site. Conclusion It is an effective method to use the perforator flap for repairing soft tissue defect of the extremities.