ABSTRACT
Objective@#To investigate the clinical effects of immediate nipple reconstruction with a local mastectomy flap in secondary breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap.@*Methods@#A free bipedicle DIEP flap was raised and folded upward to form the breast. Meanwhile, a deepithelialized lower mastectomy flap with a distant skin paddle was elevated and pulled throughout the reconstructed breast. The skin paddle was carefully sutured to the position of future nipple. Three weeks later, the pedicle of mastectomy flap was divided, and the paddle was modeled to form the new nipple.@*Results@#From February 2011 to June 2016, 42 patients who had previously undergone unilateral modified mastectomies underwent the breast reconstructions and immediate nipple reconstructions. All flaps survived postoperatively. The average projection of the reconstructed nipple was measured as (16.3±2.4) mm immediately after the operation and gradually decreased to (8.4±1.3) mm by one year follow up. 35 patients ranked the aesthetic appearance of the reconstructed nipple and breast very good or good.@*Conclusions@#The immediate nipple reconstruction with a local mastectomy flap and breast reconstruction by DIEP flap could achieve a good breast shape and maintain a long term residual nipple projection, which results in considerable patient satisfaction.
ABSTRACT
Objective To summarize experience in the treatment of chronic refractory empyema with autologous myocutaneous flap implantation.Methods From January 2004 to December 2017,26 patients had been treated with autologous myocutaneous flap implantation in Shanghai Pulmonary Hospital for chronic refractory empyema.Among them,24 were men and 2 were women.The mediam age was 50.1 years(14-74 years).21 of them had medical histories of lung resection because of basic diseases(most of which accepted surgeries in other hospitals).Complications appeared after surgeries.15 of them had bronchopleural fistula while windowing,which could not be cured by conservative treatments such as drainage.Then we performed open-window thoracostomy and long-time dressing.6 of 21 had experienced pneumonectomy.Other 5 patients did not have primary operational histories.They experienced dressing by windowing because of chronic refractory empyema after the in effective conservative treatments like drainage without pulmonary re-expansion.Results No respiratory complications occurred in these patients.The catheters were successfully removed within 5 days and the patients were discharged within 3-6 weeks after the operations.The median follow-up period was 9 months.24 cases were successful with no recurrence of empyema or flap necrosis,the other 2 cases underwent recurrence of empyema.Conclusion The application of autologous myocutaneous flaps for the treatment of chronic refractory empyema is an effective and continuously improving method.
ABSTRACT
BACKGROUND:In consideration of skin as the largest organ al over the body and its abundant vessels and vessel plexuses, there would be sufficient adult stem cels for tissue engineering. OBJECTIVE:To investigate the osteogenic potential of dermis-derived bone morphogenetic protein receptor subtype IB (BMPR-IB) positive cels. METHODS:In current study, histochemical analysis was adopted to study the localization and expression of BMPR-IB+ cels in skin. Fresh skin samples were digested into single cel suspension. Then, the surface marker BMPR-IB was used to isolate cel subpopulation by magnetic activated cel sorting from freshly prepared single cel suspension. After that, the osteogenic potential in vitro andin vivo was tested. Alkaline phosphatase staining and alizarin red staining were performed after osteogenic inductionin vitro. The BMPR-IB+ cels were seeded onto coral scaffolds, and the scaffolds were used to repair critical-sized calvarial defects of mice. Histochemical analysis was performed at 6 weeks postoperatively and micro-CT analysis was carried out at 24 weeks postoperatively to evaluate the ability of bone repairment. RESULTS AND CONCLUSION:We localized BMPR-IB cels in situ by immunohistochemistry that turned out to be expressed in the reticular layer of dermis and by single cels. Cel subpopulation which expressed BMPR-IB could be sorted by magnetic activated cel sorting. Alkaline phosphatase staining was obviously positive and lots of calcium modules were confirmed by alizarin red staining after osteogenic induction, indicating that BMPR-IB+ cels had the osteogenic potentialin vitro. Histochemical analysis demonstrated that plenty of new bone formation was found in BMPR-IB+ cels group after 6 weeks in vivo. Micro-CT analysis revealed that BMPR-IB+ cels-coral scaffold complex could repair calvarial defects successfuly after 24 weeksin vivo. These results indicated that dermis-derived BMPR-IB+ cels possessed adequate osteogenic potential. Moreover, they might be promising seed cels for bone tissue engineering.
ABSTRACT
<p><b>OBJECTIVE</b>Looking for an objective biomedical index to distinguish types and phases of hemangioma in order to provide an objective basis for selecting clinical treatment to hemangioma.</p><p><b>METHODS</b>ELISA (enzyme-linked immunosorbent assay) was used to determine serum VEGF concentration of 15 patients with proliferative hemangioma, 6 with involuted hemangioma, 6 with vascular malformation and 8 infants of the control group.</p><p><b>RESULTS</b>The serum VEGF concentrations of 15 proliferative hemangioma patients were significantly higher than those of involuted hemangioma patients, vascular malformation patients and control group infants. The serum VEGF concentrations of involuted hemangioma patients were a little bit higher than those of vascular malformation patients and control group infants, but without statistic significance.</p><p><b>CONCLUSIONS</b>ELISA could easily and accurately determine the serum VEGF concentration of different types and different phases of hemangioma. The determination of serum VEGF concentration could provide guidance for selecting a protocol of systemic corticosteroid treatment for proliferative hemangioma. Combined with gene expression and distribution of VEGF and its receptors and some other cytokines, the determination of serum VEGF concentration could help elucidate the mechanism of proliferative hemangioma.</p>