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Objective:To explore the method and clinical efficacy of Flow-through latissimus dorsi musculocutaneous flap to repair children’s limb wounds.Methods:From January, 2017 to September, 2019, the Flow-through latissimus dorsi myocutaneous flap was used to repair the limb wounds in 9 children, which were 3 cases of upper extremity wounds and 6 cases of lower extremity wounds. The patients were 5-12 years old, with an average age of 9.4 years. The wound debridement was performed in the first stage, and the wound was covered with VSD. The second operation was performed 5-8 days later. Flow-through free latissimus dorsi muscle flap was used to repair the wound, and 6 patients combined with skin grafting. During the operation, both ends of the recipient area artery were trimmed into a downward slant. The proximal end of the recipient area blood vessel was coincided with the subscapular artery, the distal end was coincided with the circumflex scapular artery, and the thoracodorsal vein and the recipient area vein were coincided. One patient had 2 thoracodorsal veins, and 8 patients had 1 thoracodorsal vein. After the operation, the patients were given anti-infection, anticoagulation and antispasmodic treatment. And regular follow-up.Results:In this group, 8 flaps survived completely, and 1 had partial epidermal necrosis, which healed under the scab. Skin grafting survives well. Nine patients were followed-up for 3 to 28 months, 7 of which were followed-up in the outpatient clinic, and 2 by WeChat. CDU showed smooth blood flow in all patients 1 month after operation, in addition of 3 after 1 year. The flap had good blood flow and soft texture. Flap plastic surgery was performed in 3 cases.Conclusion:Using Flow-through latissimus dorsi musculocutaneous flap to repair the wounds of the children’s limbs, the flap survived well after the operation, and the blood circulation of the main vessel in the affected area was smooth, which had no obvious effect on the blood supply to the distal limb of the affected area.
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Objective:Microvascular clip plays important role in microsurgery. Therefore, the development of microvascular clips and research in clamp-related vascular injuries becomes a major topic. Based on clamp-related microvascular injuries, the study investigated in 4 aspects: injury assessment, vascular characteristics and blood vessel injury, vessel repair, and development of microvascular clamp. A prospects of the current researches is also given.
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Objective:To investigate the effect of Masquelet technique combined with platelet-rich plasma (PRP) on repair of massive tibial defects.Methods:A prospective randomized controlled single blind trial was conducted in the 21 patients who had been admitted to Department of Repair and Reconstruction Surgery, Foshan Hospital of Chinese Medicine for massive tibial defects from June 2016 to June 2018.The length of bone defects ranged from 6.0 to 22.5 cm (mean, 10.8 cm)in length.They were 14 males and 7 females, aged from 29 to 60 years(mean, 42.1 years).The patients were divided into 2 groups by an en-crypting envelope with a random digital table.In the experimental group of 11 cases, the bone defects were repaired with Masquelet technique combined with PRP; in the control group of 10 cases, the bone defects were reconstructed with only Masquelet technique.The 2 groups were compared in terms of operation time, hospital stay, wound healing, weight-bearing time, bony union time, clinical union time, complications and John-er-Wruhs scores at the second stage.Results:The 2 groups were comparable due to insignificant differ-ences between them in the preoperative general data ( P>0.05).All patients were followed up for 12 to 24 months (mean, 14.9 months).There were no significant differences in operation time, hospital stay, wound healing, weight-bearing time, Johner-Wruhs scores or rate of complications at the second stage between the 2 groups ( P>0.05).The bony union time (4.5 months ± 1.2 months) and clinical union time (4.1 months ± 0.9 months) in the experimental group were significantly shorter than those (5.7 months ± 1.5 months and 5.4 months ± 1.1 months) in the control group ( P<0.05).No such postoperative complications as infection, loosening of internal fixator, bone resorption or nonunion were found in the experimental group.One case of wound infection occurred in the control group but responded to dressing change. Conclusion:Masquelet technique combined with PRP is a safe and effective reparative treatment for massive tibial defects and can speed up bone healing.
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Objective@#To study the situation of the mutations in the A(8) and A(9) loci of exon 8 of retinoblastoma protein-interacting zinc finger gene (RIZ) of keloid patients.@*Methods@#From January 2003 to December 2007, 19 outpatient and hospitalized keloid patients of our hospital were conforming to the inclusion criteria. Both 3-5 g keloid tissue and 3 mL peripheral venous blood were collected from each patient to extract their genomic DNA, and the concentration was determined. The A(8) and A(9) loci fragments of exon 8 of RIZ were amplified by polymerase chain reaction (PCR). The length of product was detected by agarose gel electrophoresis, and DNA sequencing was performed after column chromatography. The mutations of A(8) and A(9) loci fragments were searched, and the types of mutations were determined. The consistency of genetic mutations of the keloid tissue and peripheral venous blood were compared. Data were processed with McNemar test.@*Results@#The DNA concentrations of the extracted keloid tissue and peripheral venous blood were 0.54 and 0.37 μg/μL, respectively, which were above 0.10 μg/μL. The lengths of PCR products of A(8) locus fragment DNA of exon 8 of RIZ from keloid tissue and peripheral venous blood were 235 and 238 bp, respectively, and those of A(9) locus were 242 and 244 bp, respectively, which were basically the same as the designed DNA fragments. PCR products purity of A(8) locus fragment DNA of exon 8 of RIZ from keloid tissue and peripheral venous blood were 1.81 and 1.75, respectively, and those of A(9) locus were 1.82 and 1.78, respectively, which were above 1.50. Mutations in the A(8) locus of exon 8 of RIZ were observed in keloid tissue of 18 patients, totally 6 gene mutations, including 4 point mutations and 2 frameshift mutations. Mutations in the A(9) locus of exon 8 of RIZ were observed in keloid tissue of 9 patients, totally 9 gene mutations, including 7 point mutations and 2 frameshift mutations. No patient had a mutation in the A(8) or A(9) locus of exon 8 of RIZ in peripheral venous blood. Compared with those of peripheral venous blood, the mutations in the A(8) and A(9) loci of exon 8 of RIZ in keloid tissue of patients were statistically significant (χ2=16.06, 7.11, P<0.05).@*Conclusions@#Point mutations and frameshift mutations occur in the A(8) and A(9) loci of exon 8 of RIZ in keloids of patients, which may be associated with the occurrence of keloids.
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Purpose To investigate the clinicopathologic features of calcifying aponeurotic fibroma (CAF). Methods The clinical and pathologic profiles of 6 cases of CAF were retrospectively analyzed. Results CAF appeared a firm, painless and slowly growing mass with a predilection for the distal portions of the extremities in young children and adolescents. Microscopically, the tumor consis-ted mainly of benign appearing spindle cells, chondroid cells and calcific debris. Immunohistochemically, the tumor cells were positive for vimentin, HHF-35, S-100, Calponin and CD68. Conclusion CAF is a rare, locally aggressive fibroblastic lesion. It can make an accurate diagnosis by integrating the clinical location with histopathological features. Repeated minor trauma to the extremities and some embryologic cell nests maybe its pathogenesis.
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Objective To summarize the curative effect of repairing large area soft tissue defects in heel and crus by flaps with double blood-supply of posterior tibial artery perforators and saphenous nerve nutrient vessels.Methods From January 2006 to February 2012,twenty cases took operation under the guide of Continuous Wave Doppler and design of tibial artery perforator as rotation point.And in all cases,island flaps with the blood supply from saphenous nerve nutrient vessels and tibial artery perforator were retained to repair large area soft tissue defects in heel and crus.In operations,the range of flap area were ranged from 19 cm × 11 cm to 11 cm × 8 cm.Skin flaps incision was up to the patella margin level,low to medial malleolus on edge,former to crus former median line,rear to after crus median line and farthest to the surface of wound on the metatarsophalangeal joint.Results Nineteen cases survived,and 1 case of skin flap mild necrosis at the farthest side took a second-phase line skin flap to repair.Followed-up from 6 months to 24 months was taken in all cases at the mean time of 10 months,with a result of good recovery and no ulceration for the flaps.To varying degree,all flaps recover sense of pain and deep touch.Conclusion There is no wound to posterior main tibial artery in repairing large area soft tissue defects in heel and crus by flaps with double blood-supply from posterior tibial artery perforators and saphenous nerve nutrient vessels,meanwhile to maintain double blood-supply from posterior tibial artery perforators and saphenous nerve nutrient vessels and expand the range of blood supply of posterior tibial artery perforators.In this operation,a blood circulation for the flap can be guaranteed so as for a large wound in heel and crus.
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Extracellular matrix(ECM) is the research focus in organize engineering, The configuration?component and mechanics enviroment of ECM is fit for the growth and metastasis of the cell. Heterogeneous ECM is not widely used in clinical treatment for immunocompetence and ethics. This paper introduces the production?organize configuration? immunocompetence and the clinical application of heterogeneous ECM.