ABSTRACT
Objective:To investigate the clinical value of improved perforator area CTA three-dimensional reconstruction in design and harvest of anterolateral thigh perforator flap(ALTPF) and deep inferior epigastric artery perforator flap(DIEPF).Methods:Repairs of defects of oral and maxillofacial tumour resection with ALTPF for 8 patients and defects of breast tumour resection with DIEPF for 2 patients were performed from September 2021 to January 2022 in the Department of Hand and Microsurgery of Affiliated Hospital of Binzhou Medical College. According to the improved scanning parameters and drug administration protocol, patients underwent CTA scans of both thighs or abbomen before operation. The data of CTA were sent to GE AW 4.7 work station to produce three-dimensional reconstruction of perforator area and angiosome. The source artery and perforator were observed dynamically from the angiosome in the perforator area, and the specific data were measured. The perforator location was marked by HHD, and then according to the measurement data of CTA three-dimensional reconstruction marked the location, course of perforator and the course of source artery on the body surface. The data of source arteries and perforators explored during the operation were compared with preoperative three-dimensional reconstruction. The perforator locations of CTA were compared with the HHD. The harvest time and survival condition of flap were compared with the previous patients who only had the perforator location markers from HHD. The sizes of ALTPFs and DIEPFs were 4.0 cm×4.0 cm-15.0 cm×6.0 cm and 19.0 cm×7.5 cm-25.0 cm×10.0 cm, respectively. The survival of flaps and the healing of wound were observed in the postoperative follow-up in terms of appearance, texture, function of recipient site and the shape and function of the donor site.Results:Eight ALTPFs and 2 DIEPFs all survived without any adverse event. Both recipient and donor sites healed well without any complication. Seven femoral septocutaneous perforators, 2 musculocutaneous perforators and abdominal 3 perforators coursed directly, 2 tortuously perforators were seen from three-dimensional reconstruction. The types and origins of perforators explored during operation were basically consistent with three-dimensional reconstruction. The accuracy of CTA[(0.36±0.11) cm] was higher than HHD[(0.54±0.19) cm] for perforators location( t=-3.160, P<0.05). Compared with the previous group[(74.60±30.53) min], this group[(52.80±24.57) min] had a shorter time to cut out the flap of similar area( t=-9.179, P<0.05). In the previous group, one flap transfer was failed due to the thinner caliber of perforator and source artery. All the flaps survived with satisfactory outline and softness with good blood supply after 2-6 months of follow-up. The oral and maxillofacial functions were normal. The reconstructed breasts were symmetrical with the healthy side, and the shape was satisfactory. Only linear scars remained in the donor sites without dysfunction. Conclusion:The improved CTA three-dimensional reconstruction of perforator area can help to determine the detailed location, course and distribution of the perforators at the superficial fascia layer. It provides a reliable bases in the design and harvest of perforator flaps during operation, reduces the perioperative risks and has certain clinical values.
ABSTRACT
OBJECTIVE@#To explore the synergistic effect of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) on the growth of bone tissue.@*METHODS@#A total of 36 rabbits were randomly divided into 4 groups with 9 rabbits (18 sides of the anterior limb) in each group, including group A,B,C, and D. For all rabbits 1.0 cm bone defects was created in both sides of the radius. These bone defect regions were implanted with corresponding composites: group A with calcium phosphate cement (CPC) only, group B with CPC/bFGF, group C with CPC/VEGF while group D with both bFGF and VEGF. At the 3rd, 6th, and 12th week after the operation, 6 specimens from each group were randomly selected. The effects were partly assessed by X-ray film examination, bone mineral density (BMD) measurements, biomechanical test and histological observation.@*RESULTS@#X-ray showed that at the 12th week the bone defects in group D were completely repaired with CPC generally degraded,whereas bone defects in group B and C were only basically repaired. BMD measurements showed that at the 12th week the BMD of group D was significantly higher than that of group B and C (P < 0.05). Biomechanical testing(at the 12th week) showed that the maximum bending load of group D was significantly higher than that of group B and C (P < 0.05). Histological observation indicated that at the 12th week, woven bone had become mature lamellar bone in group D. At the same time, the normal relation of cortical bone and marrow had resumed, and so had the normal structure of trabecula. However, the recanalization of bone marrow cavity could not be seen in group B and C.@*CONCLUSION@#These 3 kinds of composite: CPC/bFGF, CPC/VEGF and CPC/ bFGF+VEGF can promote the growth of bone tissue and speed up the repair of bone defects. The composite of CPC/bFGF+VEGF is better than the other two composites in promoting the growth of bone tissues, indicating that bFGF and VEGF have a synergistic effect on the growth of bone tissue.
Subject(s)
Animals , Female , Male , Rabbits , Bone Cements , Calcium Phosphates , Drug Synergism , Fibroblast Growth Factor 2 , Implants, Experimental , Radius , Wounds and Injuries , General Surgery , Random Allocation , Vascular Endothelial Growth Factor AABSTRACT
BACKGROUND:Nano-hydroxyapatite/collagen (NHAC) is an ideal substitute for tissue engineered stent. Vascular endothelial growth factor (VEGF) is a kind of growth factor that can promote vascularization and slowly release NHAC. This indicated a good bone tissue repair function. OBJECTIVE:To investigate the effect of NHAC combined with VEGF in repairing bone defects. DESIGN,TIME AND SETTING:The randomized controlled animal study was performed at the Animal Laboratory,Xiangya Medical College,Central South University from October 2008 to January 2009. MATERIALS:Nano-hydroxyapatite powder and collagen protein powder were mixed and prepared into NHAC artificial bone according to the ratio of 8:2. 2 ?g of VEGF and NHAC were mixed and prepared into NHAC/VEGF artificial bone according to the ratio of 1.8:1. Each artificial bone contained 0.5 g nano-hydroxyapatite powder,0.125 g collagen protein and 150 ng VEGF. METHODS:Thirty-six healthy rabbits whose left radiuses were cut off 1 cm were divided into three groups. The wounds of the rabbits in blank group were sewed up directly without any treatment of the bone. The bone defects of the rabbits in NHAC group were repaired with NHAC artificial bones and the NHAC/VEGF group with NHAC/VEGF artificial bones. MAIN OUTCOME MEASURES:After 2,4 and 8 weeks,4 rabbits in each group were killed to evaluate whether they have significant differences of bone healing according to general observation,radiograph,pathological section and bone density test. RESULTS:Radiograph showed that osteotylus growth and the repairing of bone defects in the NHAC/VEGF group were better than in the blank group and NHAC group. It was better in the NHAC group than in the blank group. The difference in bone density of two groups in the same time was significant (P