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In the development of flap surgery, the groin flap was one of the earliest flaps used in repair of soft tissue defect. However, due to its unstable anatomical position and many variations, small vessels and great difficulty in vascular anastomosis, the application of this flap reduced gradually. With the development of microsurgical techniques and the increasing demand of patients for aesthetics in donor site, the groin flap has been still widely used in the repair of soft tissue defect in limb maxillofacial region, and perineal partsin in recent 10 years, due to its advantages of concealed donor site and large area of flap. This article review the historical development of the groin flap, summarize the clinical application of perforator flap, and special types of groin flaps in repair of soft tissue defect in extremities. Hoping to further promote the application and development of groin flap in soft tissue repair.
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Objective To evaluate the effectiveness of flexor hallucis longus tendon transfer in treatment of chronic Achilles tendinopathy using different technique.Methods Sixty-four embalmed feet of 32 cadavers were analyzed and classified anatomically with respect to the individual cross links in the Henry's knot.These three techniques were then combined to determine the total potential tendon graft length obtainable using single incision,double incision and minimally invasive incision.From January,2012 to June,2015,10 patients (10 feet) with chronic Achilles tendinopathy were treated with double incision technique.The score was 63.04 ±7.75 according to American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system.Results Only two different configurations were found.Type 1,a tendinous slip branched from the FHLT to the FDLT was 96.9％(62 of 64 feet).Type 2,a slip branched from the FHLT to the FDLT and another slip from the FDLT to FHLT was 3.1％(2 of 64).The average length of the FHLT graft available from a single incision measured (5.08±1.09)cm,double incision technique measured (6.72 ± 1.02) cm,and minimally invasive incision measured (17.49 ± 1.80)cm.The difference between the lengths obtained from these three techniques was statistically significant.Ten patients were followed-up 12-36 months (mean,13.7 months).At 12 months after operation,the AOFAS ankle and hindfoot score was 93.28 ± 3.72,showing significant difference when compared with that before operation.The results were excellent in 6 cases,good in 3 cases,and fair in 1 case with an excellent and good rate of 90％.No sural nerve injury,posterior tibial nerve injury,medial plantar nerve injury,and lateral plantar nerve injury occurred.Conclusion In over 96 ％ of the feet,a proximal to distal connection from the FHLT to the FDLT was found,which might contribute to the residual function of the lesser toes after FDLT transfer.The distal stump of the FHLT tendon should be sutured onto the FDLT tendon under tension to en able a co-activation of the great toe,preserved hallux plantar flexion.Chronic Achilles tendinopathy reconstruction with flexor hallucis longus tendon harvested using double incision technique offers a desirable outcome in operative recovery,tendon fixation,preserved hallux plantar flexion and less complications.
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Objective To prospectively summary the piercing-out position,direction,length and piercing-in position of perforator,and investigate the feasibility of preoperative design and optimization of the anterolateral thigh flap and its clinical application.Methods All 58 cases of anterolateral thigh flaps were designed and taken from the lateral thigh area from January,2014 to January,2016.Portable Doppler ultrasound was used before an operation to detect the piercing-out position (point P) of perforators.The direction and length (lower subcutaneous segment of perforators) of perforators after leaving piercing-out position were observed during the operation.And the piercing-in positions (point P') on superficial fascia and the dermis were observed.Based on this,we added line B (anterior superior spine-lateral femoral epicondyle) and line C (anterior superior spine-the middle point of superior border of patella) in the lateral and anterior side of original ilium-patella line in the thigh (line A),respectively.Results All perforators found in 58 cases before and during the operations were located on line A or between line A and line B.No perforators were found between line A and line C.Perforators walked toward the anterior medial side after leaving the muscle membrane.The perforator vascular subcutaneous segment (distance between point P and point P') was (2.02±0.23) cm.There was rectus muscle branch in the descending branch of lateral femoral circumflex artery,while no rectus muscle cutaneous branch was seen.20 cases were designed by one-line method,12 cases were designed by two-line method,while 26 cases were designed by three-line method.Conclusion Advanced three-line method is beneficial to detect of the perforators on the anterior thigh lateral region and to reduce the intraoperative injury perforator vessels at the puncture point.Clinical application of the anterior lateral thigh flap is simple and reliable.
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<p><b>OBJECTIVE</b>To investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot.</p><p><b>METHODS</b>In the anatomic study, 50 cadaveric feet were injected with red latex and the anastomosis, distribution and external diameters of medialtarsal artery, medial anterior malleolus artery, medial plantar artery, the superficial branch of the medial basal hallucal artery and saphenousnerve nutritional vessels were observed. Based on anatomic research results, we designed the reverse saphenous nerve neurocutaneous flaps for repairing skin defects of forefoot.</p><p><b>RESULTS</b>The blood supply of reverse saphenous nerve neurocutaneous flaps were based on the vasoganglion, which consist of arterial arch at the superior border of abductor hallucis and arterial network on the surface of abductor hallucis around the saphenous nerve and medial pedis flap. From Oct. 2006 to Oct. 2011, the reverse saphenous nerve neurocutaneous flaps were used to repair skin defects of forefoot in 11 cases. The flap size ranged from 2.5 cm x 3.5 cm to 7.5 cm x 8.5 cm. The wounds at donor site were covered with full-thickness skin graft. All flaps survived completely with no ulcer at the donor site. 11 cases were followed up for 6 to 18 months( mean, 10 months). The skin color and texture were satisfactory. The patients could walk very well.</p><p><b>CONCLUSIONS</b>It is reliable to repair the skin defects of forefoot with reverse saphenous nerve neurocutaneous flaps. It is easily performed with less morbidity. This flap should be considered as a preferential way to reconstruct skin defects of forefoot.</p>
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Female , Humans , Male , Arteries , Cadaver , Foot , Forefoot, Human , Wounds and Injuries , General Surgery , Muscle, Skeletal , Plastic Surgery Procedures , Skin Transplantation , Methods , Surgical Flaps , Transplant Donor Site , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To explore the method of the treatment for hallux valgus with the proximal crescentic osteotomy of the first metatarsal bone, combining with distal lateral soft tissue release.</p><p><b>METHODS</b>From January 2008 to December 2012, 21 cases 21 hallux valgus feet were treated by operative procedure, included 1 male (1 foot) and 20 females (20 feet), with the mean age of 52 years (range, 36-68 years). Among all patients were followed up for 12 to 26 months, with the mean 16 months. The preoperative, post-operative and final follow-up X-ray films of all patients were collected. The hallux valgus angle, intermetatarsal angle and distal metatarsal articular angle were measured and analyzed. The surgical outcome was evaluated combined with the AOFAS score.</p><p><b>RESULTS</b>The average hallux valgus angle decreased from 42.3° ± 1.8° preoperatively to 14.5° ± 1.8 postoperatively, the average intermetatarsal angle did from 21.9° ± 1.7 to 9.1° ± 1.8°, and the average distal metatarsal articular angle did from 14.9° ± 1.8 to 7.2° ± 1.5, respectively. There were significant differences between the preoperative and postoperative roentgenographic index. AOFAS score was improved from 44.0 ± 1.8 preoperatively to 83.9 ± 2.2 at the final follow-up.</p><p><b>CONCLUSIONS</b>The proximal crescentic osteotomy of the first metatarsal bone combined distal soft tissue reconstruction obtained satisfactory results in severe hallux valgus patients with big intermetatarsal angle.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Dermatologic Surgical Procedures , Methods , Hallux Valgus , General Surgery , Metatarsal Bones , General Surgery , Osteotomy , MethodsABSTRACT
Objective To investigate the anatomy of the superficial epigastric artery perforator flap , and to provide anatomical basis for harvesting flap .Methods Of 27 SD rats, 7 were used for gross anatomy observation and anatomic characteristics and 20 rats for lead oxide-gelatin injection followed by computer picture processing , measurements and the related parameters recording .Results The superficial epigastric artery originated from femoral artery , and gave off its first branch when passed through the superficial fascia .The trunk branched into a lateral perforator and a medial perforator , which anastomosed with thoracodorsal artery and lateral thoracic artery , respectively .The average external diameter of superficial epigastric artery was (0.46 ±0.02)mm at its starting point,and(0.46 ±0.02)mm at the superficial fascia level . The nutritive area of superficial epigastric artery was (18.37 ±3.67) cm2 .The anastomosed area with thoracodorsal artery and lateral thoracic artery was(5.34 ±0.86)cm and(6.28 ±0.29)cm, respectively, away from the horizontal line through axillary,and (4.38 ±0.38)cm and(2.04 ±0.33)cm, respectively, away from the ventral median line.Conclusion The position and external diameter of superficial epigastric artery are constant , and the superficial epigastric artery perforator flap is a ideal flap model for research on free flap transplantation , flap supercharging , and hemodynamics .
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Objective To explore the methods of repairing great toe soft tissue defect with the reverse medial pedis island flap with transverse artery of great toe.Methods This study was made up of two parts:an anatomical study and clinical application.In the anatomical study,49 cadaveric feet were injected with red latex and then anostomosis,distribution and external diameters of transverse artery of great toe,the deep branches of the first plantar metatarsal arteries and the deep branches of medial plantar artery were observed.From September 2006 to December 2012,8 cases of soft-tissue defects with the retrograde-flow medial pedis island flaps were harvested to cover the soft tissue defects of great toe.Soft tissue defect was form 2.5 cm × 3.5 cm-3.5 × 4.5 cm.Results There was an arterial circle under the first metatarsophalangeal joint which consisted of transverse artery of great toe,tibial proper plantar digital artery of great toe,fibular proper plantar digital artery of great toe and the distal part of first plantar metatarsal artery.This arterial circle under the first metatarsophalangeal joint and arterial network on the surface of abductor hallucis was responsible for the blood supply of the flap of medial pedis.The diameter of the pedicle was great,and the length of the pedicle was longer than in previous reported.In terms of clinical application,all patients were followed up with the mean of 10 months (range fromn 6-24 months).All flaps survived totally without diabrosis and swelling.The walking and weight-bearing were normal and the blood supply of foot was good.Conclusion Using of arterial circle under the first metatarsophalangeal joint,the medial pedis island flap has a reliable retrograde blood supply.The reverse point of the reverse medial pedis flap moved forward to th interphalangeal joint.This flap should be considered as a preferential way to reconstruct soft-tissue defects of the great toe.
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Objective To discuss the TARP (transoral pharyngeal atlanto axioal reduction plate,TARP) stress distribution under the condition of atlantoaxial dislocation treatment with the TARP system and explore the possible suggestion for the further innovation of the TARP system.Methods A fixed Finite Element model was constructed for transoral atlantoaxial reduction plate system based on the CT digital data of the China Digital Human NO.1.The internal structure changes and the stress distribution of TARP system under different loads were imitated and analyzed.Results The results showed that,after the fixation of the TARP system,different parts of the atlantoaxial had different stress under anteflexion,extension,lateral bending and rotation,the internal fixation parts located mainly at the mid-part of the TARP(0.159 × 108 ～0.732 × 108 Pa) and the root of the screw(0.214 × 109 ～0.958 × 109 Pa).Beside that,when using anteflexion,the stress mainly focused on the articular surface of the atlantoaxial(0.512 × 107 Pa).As for extension,the stress mainly focused on the part between the lateral mass and anterior arch (0.582 × 107 Pa).While lateral bending or rotation,the stress mainly focused on the axial screw nailing path (0.287 × 109 Pa and 0.241 × 109 Pa).Conclusions Although different parts of the TARP plate have different stress,its maximum stress lied in the root of the screw.The stress of plate mainly focused on the mid - part,no matter in what state of motion,therefore,the root of the screw and the mid-part of the plate bore the biggest stress,their strength decided the fatigue property of the TARP system.
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Objective To discuss anatomical characteristics and clinical results of the lateral superior genicular artery perforator iliotibial band flap. Methods From September 1999 to July 2009, the origin,course, branches and distribution of the lateral superior genicular artery and blood supply of iliotibial band were observed on 40 sides adult lower limbs perfused with red latax. Five perforator iliotibial band and 4 perforator iliotibial band flaps of 9 cases were treated with anastomosis of lateral superior genicular artery perforating rami. Results The lateral superior genicular artery of 35 cases (80%) originates from the popliteal artery. Its originated external diameter was (1.8 ± 0.4) mm. It divides into ascending branch and descending branch, and they gives off septofascio-cutaneous perforator, or anatomoses the lateral uppermost genicular artery in the vastus lateralis muscle, and then formes the musculocutaneous perforator of iliotibial band. The originated external diameter of the larger perforator of iliotibial bands was ( 1.0 ± 0.2) mm and they provides for the skin and iliotibial band of lateral superior genicular area. Nine cases, including 5 cases of simple Achilles tendon defects, two cases of achilles tendon defects with skin defects, and 2 cases of lower extremity and foot soft tissue defects were treated with transplantation of the vascularized iliotibial band (flap) with perforator vascular anastomoses. All cases were followed up 6 - 92 months. The results showed significant improvement in "heel test" and Thompson sign in the rerupture of the Achilles tendon occurred. Four perforator iliotibial band flaps survived well. Conclusion The lateral superior genicular artery perforator iliotibial band flap is a practical, simple and new donor in the reconstruction of soft tissue and composite defects.
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ObjectiveTo study the types of anatomical variations of hepatic arteries. Methods Hepatic arteries of 64-slice spiral CT scanning data were three-dimensional constructed by using self-designed software. The types of anatomical variations were analyzed and classified with Michels' classification criteria. Results The model presented with realistic profile of hepatic arteries which allowed vivid three-dimensional observation. Of these patients, 40 had normal hepatic arteries (60.61%), 26 had variations (39.39%), and 5 had infrequent aberrant hepatic arteries that was not included in Michels' classification (7.58%). Conclusion Three-dimensional model of hepatic arteries can volumetricly display the anatomical variations of hepatic arteries.
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BACKGROUND: Studies of spinal biomechanics are conducted based on three-dimensional finite element model. The biomechanics of lower thoracic vertebra requires accurate and precise finite element models due to its structural characteristics. Currently, cervical and lumbar finite element models have been explored, but the studies of lower thoracic vertebra remains unclear.OBJECTIVE: Using reverse engineering software to reconstruct three-dimensional finite element model of lower thoracic vertebra, to lay a foundation for further biomechanical research. METHODS: imaging samples of one case with no spinal disease or osteoporosis were selected from Affiliated Hospital of Inner Mongolia Medical College. Informed content was obtained. Using non-spinal-disease CT data, three-dimensional finite element model Of lower thoracic vertebrae and intervertebral discs were reconstructed with Mimics, Gomagic and Ansys softwares. RESULTS AND CONCLUSION: Using reverse engineering software in combination with CT technique, the three-dimensional finite element model of lower thoracic vertebrae was reconstructed. The model accurately showed their anatomic characteristics and discrimination of inner structure. The lower thoracic vertebrae was divided into 112 540 tetrahedron elements. Results show that using reverse engineering software, a three-dimensional finite element model of lower thoracic vertebrae was successfully reconstructed, with high efficiency of establishment and simple operation.
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@#Objective To study the surgical approach of the jugular foramen and the clinical anatomy of the transmastoid endoscoPy-assisted jugular foramen surgery.Method The transmastoid endoscopy-assisted jugular foramen surgery was simulated in 15 adult cadaveric specimens(3O side). The main anatomic mark in the surgical approach was studied,and the distance between the important stmcture to the glomus jugular has been measured. Results The distance between the glomus jugular and the Vertlcal segmental of the facial nerve,the anterior wall of the glomus jugular to the facial nerve,the glomus jugular to the posterior semicircular canal and tympanic cavity were(3.58±1.32)mm,(5.07±2.93)mm,(4.68±3.47)mm and(0.14±4.32)mm.In 30 cases,the top of the glomus jugular inferior the tympanic cavty in 5cases, 7 cases behind the facial nerve and the tympanic, 16 cases the facial Berve is m the middle of the glomus iugular. 2 cases is near the inferior wall of internal auditory meatus.the cranial nerve and blood vessel in the jugular foramen is clearly to be show. Conclusion It is a samPle and little damaged way to use the transmastoid endoscopy-assisted jugular foramen surgery and it is hopeful to Protect function of the facial Berve,acoustic nerve and the post-cranial nerve.
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BACKGROUND: A lot of important organs are worthless for clinical application because they are hard to store for a long time. In addition, tissues or organs which are dealt with cryopreservation also attack ischemia/reperfusion injury with the recovery of blood flow; especially, skeletal muscle is the most involved tissue.OBJECTIVE: To observe the protective influence of edaravone on cellular membrane and mitochondria of replanted rat extremities following ischemia/reperfusion injury due to cryopreservation and rewarming.DESIGN: Randomized contrast animal study.SETTING: Basic Medical College of Southern Medical University; Department of Hand and Foot Surgery, Shandong Provincial Hospital.MATERIALS: The experiment was carried out in the Cryopreservation Laboratory, Shandong Provincial Hospital from April to November 2006. A total of 36 healthy adult male Wistar rats were provided by Experimental Animal Center of Medical College of Shandong University. All rats were randomly divided into control group, cryopreservation group and edaravone group with 12 in each group.METHODS: Femoral artery and vein of rats in control group were exposured, but extremities were not blocked. Rats in other two groups were used to establish ischemia/reperfusion injury models of replanted extremities. Before cryopreservation, their right hindlimbs were cut off and maintained in liquid nitrogen container for 1 month. After the operation mentioned above, the broken limbs were rewarmed, perfused with routine eluant and replanted. Four hours later, blood supply of extremities was recirculated and the samples were selected. Eluant in edaravone group contained 0.5 mg/kg edaravone. Samples of skeletal muscle were selected at the same time point to establish cellular membrane and extract mitochondria. Furthermore, fluorescence polarization of cellular membrane (reflecting liquidity in cellular membrane lipid area), malondialdehyde (MDA) content of mitochondria, superoxide dismutase (SOD) activity and respiratory controlling rate were measured; meanwhile, mitochondrial ultrastructure of skeletal muscle was observed under transmission electron microscope.MAIN OUTCOME MEASURES:①Fluorescence polarization of cellular membrane, MDA content of mitochondria, SOD activity and respiratory controlling rate of skeletal muscle; ②mitochondrial ultrastructure of skeletal muscle.RESULTS: All 36 rats were involved in the final analysis without any loss. ①SOD activity and respiratory controlling rate of mitochondria in skeletal muscle: The values of these two items were higher in edaravone group that those in cryopreservation group (P＜0.05).②Fluorescence polarization of cellular membrane and MDA content of mitochondria in skeletal muscle: The values of these two items were lower in edaravone group than those in cryopreservation group (P＜0.05). ③Mitochondrial ultrastructure of skeletal muscle: Injured degree of skeletal muscle was milder in edaravone group than that in cryopreservation group.CONCLUSION: Edaravone can relieve ischemia/reperfusion injury of skeletal muscle and protect cellular membrane and mitochondria of skeletal muscle. Its mechanism may be related to directly inhibiting hydroxy free radicals, increasing SOD activity of skeletal muscle, reducing generation of MDA and promoting normal oxidative phosphorylation.
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OBJECTIVE To study the anatomical dimension of the path to the petrous apex via the infralabyrinthine approach. METHODS Thirty dry temporal bones were dissected along the internal carotid canal. The distances from the vertical portion of the facial nerve to the genu of the internal carotid canal,the vertical portion of the facial nerve to the petrous apex,the genu of the internal carotid canal to the posterior surface of the petrous bone were measured. Ten heads of adult cadaver were dissected to gain access to the petrous apex via the infralabyrinthine approach. The horizontal and vertical dimensions of the approach window created were measured. RESULTS The vertical portion of the facial nerve to the lap of the internal carotid canal was (13.26?1.66)mm,portion of the facial nerve to the petrous apex was (34.48?1.07)mm,the lap of the internal carotid canal to the posterior surface of the petrous bone was (9.68?1.53)mm. The mean dimensions of the window in dissected bones were(5.76?3.38)mm vertically and (6.42?2.65)mm horizontally. Thirteen sides had been doing well with the infralabyrinthine approach. CONCLUSION The possibility of those anatomical variations should be considered when the infralabyrinthine approach is being planned to manage the petrous apex lesion. The infralabyrinthine approach is useful to the patients with good hearing.
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BACKGROUND: Although hand urgical doctors have drawn the attentions to carpal diseases mainly manifesting as carpalinstability, it is still expected to carry on the researches on biomechanical properties of Chinese carpal ligaments. OBJECTIVE: To understand the biomechanical properties of partial carpal ligaments so as to provide experimental evidence for the development ofclinical hand surgery. DESIGN: A simple specimen study.SETTING:Department of Orthopaedics,Kunming General Hospital of Chengdu Military Area Command of Chinese PLA,and Institute of Clinical Anatomy, First Military Medical University of Chinese PLA.PARTICIPANTS: Sixteen fresh specimens from Chinese adult wrists were obtained from the Departmentof Anatomy, First MilitaryMedical University of Chinese PLA and the experiment was performed in the Laboratory of Biomechanics. INTERVENTIONS:The partial carpalligaments were stretched till fragmentation of ligaments by using the SWD-10materialtesting machine, at the rated velocity of 5 mm per minute so as to determine the biomechanical properties of carpal ligaments. MAIN OUTCOME MEASURES:The tolerated maximum tension and rigidity during fragmentation of radioscaphoid ligament,radioscaphocapitate (RSC) ligament, radiolunate ligament, ulnolunate (UL) ligament, ulnotriquetral(UT) ligament,ulnar bursa,scapholunate interosseous(SLI) ligament,and lunotriquetral interosseous(LTI) ligament. RESULTS: Among the ligaments attached between distal radioulnar bone and carpal bone, the maximum tension and rigidity of UL ligament were the strongest, (219.2 ±55.4) N and (65.5 ± 19.6) N/mm2, of UT ligament and ulnar bursa were the weakest, (54.0 ±25.5) N, (17.8 ± 6.0) N/mm2and (58.7 ± 17.6) N, (13.4 ±4.7) N/mm2 respectively, of SLI ligament was stronger, (286. 1 ±90.8) N, (95.5 ±40.0) N/mm2, and of LTI ligament were more stronger, (375.3 ± 52.6)N, (179.0 ± 39.0 N/mm2.CONCLUSION: Among carpal ligaments, the maximum tension and rigidity of proximal row of intercarpal ligaments were stronger than those of the ligaments attached between distal radioulnar bone and carpal bone. Of proximal row of intercarpal ligaments,the maximum tension and rigidity of LTI ligament were stronger than those of SLI ligament. Of the ligaments attached between distal radioulnar bone and carpal bone,the maximum tension and rigidity of UL ligament were the strongest.
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Objective To investigate the anatomic and histological properties of carpal ligaments. Methods 34 cadaver specimens of adult wrists were prepared, of which 32 were fixed in formalin and 2 were fresh. We dissected the specimens and observed the origination, insertion, course, spatial relationship of carpal ligaments with the radiocarpal joint capsule and neighboring relationship with each other. The width and thickness of middle segment of each carpal ligament as well as the length were measured. 8 cadaver specimens of adult wrists were dissected and encircled by paraffin wax. Partial carpal ligaments were sectioned and stained with hematoxylin and eosin. Then they were put under a light microscope for observation. Results The radioscaphoid, radioscaphocapitate and radiolunate ligaments were found to have similar tissue structures. They were composed of wavy and tendinous collagen fiber fascicles, among which a small amount of loose tissue was found to be intermingled with vessels. The radioscapholunate ligament was mainly composed of loose connective tissue with no bulky tendinous collagen fiber fascicles, few fiber fascicles but rich vessel bundles. The palmar, dorsal and proximal regions of the scapholunate interosseous ligament and the lunotriquetrum interosseous ligament had different histological properties. The difference was especially obvious in the proximal regions compared with the dorsal and palmar regions. The dorsal regions of the 2 ligaments were mainly composed of bulky and bunchy transverse collagen fiber fascicles while the palmar region was composed of oblique ones. The proximal regions of the 2 ligaments were mainly composed of fibrocartilage with no vessels or nerves. At the joining part between the radioscapholunate ligament and the scapholunate interosseous ligament, the vessel bundles of the radioscapholunate ligament were noticed to penetrate the scapholunate interosseous ligament in the palmar region. Conclusions The major ligaments of the wrist are palmar. The palmar ligaments are stronger than dorsal ligaments. Many adjacent ligaments oriented in a V- shaped configuration, which can strengthen the wrist stability. Most of the carpal ligaments are mainly composed of dense and bulky collagen fiber fascicles, but the radioscapholunate ligament is mainly composed of loose connective tissue blending with rich vessels, which fulfill the function of supplying blood. The proximal regions of the scapholunate and lunotriquetrum interosseous ligaments are mainly composed of fibrocartilage structure with no vessels among them.
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Objective To investigate the course of the mandibular branch of the facial nerve and to discuss its clinical significant in the rhytidectomy. Methods The distribution of the mandibular branch was observed in 30 halves of the fifteen candaveric specimens (ten antiseptic cadaveric specimens and five fresh cadaveric specimens). Results The mandibular branch could be divided into the isolated branch type and shared branch type, after it exited from the parotid gland. 63.33 % mandibular branch was found (2.1?0.7) cm superior to the palpable edge of the mandibular bone; 23.33 % mandibular branch was along the edge of the bone; and 13.33 % was found (1.8?0.5)cm inferior to the palpable edge of the bone. Conclusion The distribution of the mandibular branch locates in the area that is a digit superior and inferior to the lower border of the mandibular bone, which arises from the angle of the mandibular bone. The dissection beneath the SMAS-platysma should be with caution of the injury of the ramification of mandibular branch in the anterior border of the masseter muscle.[
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<p><b>OBJECTIVE</b>To introduce a method of repairing facial tissue defects caused by various factors.</p><p><b>METHODS</b>The reverse narrow pedicle lateral maxillocervical fasciocutaneous flap was designed with its pedicle located in front of auricle. The size of the flaps ranged from 5 cm x 6 cm to 10 cm x 11 cm. The length and width of the pedicle ranged 2 cm-5 cm and 1 cm-1.5 cm.</p><p><b>RESULTS</b>This fasciocutaneous flap was used in 21 cases. All flaps survived except 1 flap showing distal skin necrosis.</p><p><b>CONCLUSION</b>This fasciocutaneous flap didn't include any major blood vessel. The ratio of the pedicle width to flap length broke that of traditional flap and was reverse transfer. The transposition of the narrow pedicle flap was easy. The postoperative appearance (color, texture, cosmetic aspect) was satisfactory. This method was a new design and was ideal for large facial tissue defect repair.</p>
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Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Face , General Surgery , Surgical FlapsABSTRACT
AIM: To explore the histocompatibility of pinealocyte microencapsules in vivo. METHODS: The pineal glands of neonatal rats were removed under operating microscope and pinealocytes were isolated through collagenase and trypsin digestion. Pinealocytes were cultured for one week in vitro and collected immediately after digesting was encapsulated in APA microencapsules. The cells and empty capsules were transplanted into abdominal cavity or intermuscular space respectively and retrieved at the 15th or 30th day after operation. Morphological observation, HE staining, cell counting, and HPLC technique were used to analyze the shape, proliferation and function, the degree of inflammation fibrosis of retrieved microencapsules. RESULTS: The retrieve rate of cell capsule from abdominal cavity was about 85 % . The retrieved capsules had integrated profile mostly although some were damaged. The amount of macrophages attached to capsule wall and the thickness of wall increased gradually following the period of transplantation. However, the retrieve rate, wall thickness had no difference between retrieved cell and empty capsules at the same time. Secretion ability of pinealocytes in capsule retrieved at 15th day after operation decreased rapidly and those retrieved at 30th day after operation lossed secretion function. CONCLUSION: APA microencapsules had histocompatibility relatively in vivo and protected pinealocytes in capsule from immunologic rejection of the host. The survival time was about 20 days. During this period cells in capsule maintained activity and MT secretion ability.
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Objective To explore the arterial origin and the artery distribution to the brachial plexus and its clinical significance. Methods 1)To observe the zonal pattern of arteries supplying brachial plexus in three fresh cadavers by means of modified lead-oxide and gelatin infusion and radiologic development. 2)To observe the arterial origin and distribution under microscope in 10 cadavers embalmed which were injected with red latex from the common carotid artery. Results The brachial plexus was supplied by branches of the subclavian-axillary axis (SAA), and these branches anastomose each other, according to their distribution feature, the supplied neural structures were divided into three zones. The first zone including the nerve roots from intervertebral foramina to the trunks and this region of the brachial plexus were supplied by the vertebral artery and the deep cervical artery. The second zone including the divisions and the main region of the cords of the brachial plexus were supplied by direct branches of the subclavian artery or by branches originating from the dorsal scapular artery. The dorsal scapular artery was usually thick and contributed to blood supply of a large region. There were 2.7 (1-5) direct branches of the subcalvian artery on the average which have relatively smaller diameter. The third zone including the distal portion of the cords and the terminal branches of the brachial plexus were supplied by direct branches of the axillary artery. The mean number of these branches was 3.4 (1-6). Conclusion The brachial plexus has plenty of vascular supply which can be divided into three zones. Every vasa nervorum tends to divide into a distal branch and a proximal branch shortly after they enter the brachial plexus. The branches from vasa nervorum communicates without changing their diameter which is called "real connection", and the blood supplied from the three zones can compensate each other, which provide a rich longitudinal blood supply to the brachial plexus. This study provides an anatomical basis for vascularized brachial plexus replacement.