ABSTRACT
Limbs’soft tissue injury is complex，often accompanied by vascular injury. Improper treatment will bring disastrous consequences including serious disability even amputation. Numerous evaluation criteria are available for limbs’soft tissue injury，but there is no unified standard. Accurate injury assessment is not only the basis of treatment but also a clinical difficulty. Treatment regimes are controversial，for example，different opinions on repair at stage I or stage II and on repair using traditional stair-step method or perforator flap when treating the same injury. The authors have a discussion on soft tissue injury with regards to its characteristics and assessment，treatment concept and treatment points，so as to provide references for the treatment of limbs’ soft tissue injury.
ABSTRACT
Aim To explore whether histone modifications are involved in the process of uterine injury alleviated by TSA in female mice induced by cigarette smoke (CS) exposure. Methods Female mice were exposed to CS twice daily for 30 days and TSA was injected intraperitoneally into CS-exposed mice on alternate days in the TSA-treated group. HE staining was used to observe the morphological changes of mice uterus after CS exposure; Western blot was used to assess the global modification levels of H3K4mel, H3K4me2, H3K4me3, H3K9mel, H3K9me2, H3K9me3 and H3K27me3 in uteri. GLP (H3K9 his-tone methyltransferase) , G9a (H3K9 histone methyl- transferase) , EZH2 (H3K27me3 histone methyltrans ferase ). Results TSA effectively restored the number of glandular and interstitial cells reduced by CS exposure. Western blot results showed that TSA significantly inhibited global H3K9mel modification and further aggravated H3K27me3 change induced by CS exposure. Furthermore TSA suppressed GLP and G9n expression in mouse uterine tissue induced by CS exposure, but further activated EZH2 increase. Conclusions Histone modifications are involved in the process of uterine injury alleviated by TSA in female mice induced by cigarette smoke exposure.
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Objective To explore the method of limb salvage therapy for hand and foot destructive injury, and to clarify the role of free tissue transplantation in limb salvage therapy in patients with hand and foot destructive injury. Methods From January, 2015 to January, 2016, 17 hand and foot destructive injuried patients were treated with limb salvage. The anterolateral thigh free flap, free fibular flap and arterial vein flap were used to repair the skin, soft tissue and bone defects. All patients were followed-up for 12 months. The appearance and function of the patients were evalu-ated after the treatment. The hand scoring criterion was the finger replantation function evaluation standard on probation of the Chinese Medical Association of Hand Surgery. The foot scoring criterion was the Maryland score system. Re-sults All flaps survived in 17 patients. One flap had vascular crisis after operation, and survived after vascular ex-ploratory operation. One case had infection postoperation and healed after several debridements. After 12 months, the functional scores were excellent in 5 cases, good in 5 cases, moderate in 3 cases and poor in 4 cases. Conclusion The early repair with free tissue transplantation can preserve limb length, cover the exposed bone and tendon, and improve the anti-infective ability, so as to improve the function of limb salvage and patient 's satisfaction.
ABSTRACT
Objective To explore the curative effect of fibular flap with limbs composite soft-tissue.Methods From February,2013 to February,2016,13 cases with body severe trauma patients were treated,which including 5 cases of upper limbs and 8 cases of lower limbs,and all existed bone defect,soft tissue defect and trunk vessel defect.Three cases with limbs distal non blood supply were emergency treated with debridment and flow-through fibular flap transplantation renovation,peroneal artery repairing defective blood vesscls to rcstorc limbs distal blood supply,fibular flap repairing bone defect,skin flap repairing soft tissue defect.The limb blood supply for other 10 cases were in good condition,but one case with main artery defect did the second phase of fibular flap transplantation and repaired defective blood vessels,bone and skin soft tissue synchronously according to wound condition.According to the postoperative observation for flap survival and appearance,X-ray films to observe fracture healing after 6 weeks,three months and 6 months of operation as well as evaluating limb function recovery,then analyzed the results.Results Flaps survived successfully for 11 cases,and flaps for the other 2 cases were partial necrosis.One Case was edge flap necrosis,heal scabby after dressing,and the other case was necrosis for 1/3 of the area,but the deep fascia survival,and the skin graft healing after dressing.One case with forearm rolling was in vascular crisis after operation,but tbe crisis was relieved after detection,and fingers blood supply was recovered.All the patients were followed up for 6 to 36 months(mean,14 months).All flaps were survived,fractures healed well and limbs distal blood supply was good.Bone healing time was 8 to 24 weeks,and patients with lower limbs injury could bear load after 3 to 8 months.Lower limbs restored walking function.Upper limbs and hands restored rotation function.Transplant flapshad good elasticity and satisfactory appearance.Conclusion Using fibular flap to repair defective blood vessels,bone and soft tissue synchronously,not only can rescue the limbs on the verge of amputation,but also can repair defective composite tissue and get a good prognosis.It is an effective method for open injuries severely treatment in clinic.