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Objective:To investigate the preoperative risk factors affecting early extremity blood supply after repair of major arterial injury so as to provide clues for prevention of limb ischemia.Methods:The clinical data were retrospectively analyzed of the 139 patients (140 extremities) with major extremity arterial injury who had been admitted to Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, The First Hospital Affiliated to Sun Yat-sen University from January 2003 to December 2019. There were 112 males and 27 females, with a mean age of 30 (20, 44) years. The primary outcome was the early status of blood supply to the injured extremity (48 hours after surgery). Univariate analysis was conducted of such factors as gender, age, ischemia time, injury mechanism, injury site, fracture, soft tissue lesion, and duration of surgery. The significant factors ( P<0.1) were then analyzed by logistic regression, and P<0.05 was considered statistically significant. Results:Ischemia happened in 44 (31.4%, 44/140) extremities within 48 hours after surgery. There were significant differences in injury mechanism, ischemia time, fracture, and soft tissue lesion between patients with and without postoperative extremity ischemia ( P<0.05). Logistic regression analysis indicated that blunt injury ( OR=5.639, 95% CI: 1.068 to 29.761, P=0.042) and soft tissue lesion ( OR=12.568, 95% CI: 3.402 to 46.431, P<0.001) were significant preoperative risk factors affecting the early blood supply after repair of major extremity arterial injury. Conclusion:As blunt injury and soft tissue defect are preoperative risk factors for early extremity ischemia after repair of major extremity arterial injury, surgeons should pay more attention to them when assessing patients and making repair protocols.
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Report a case sustained Gustilo type III C open fracture of the left humerus with brachial artery injury who has limb ischemia and wound infection after operation in June, 2014. To salvage the limb, performed cross limb vessel transfer to restore blood supply at one-stage. After multiple debridement, Flow-through flap transfer was performed for definitive reconstruction of the arterial injury and repair the wound in secondary stage. In the 3rd stage, cutting the pedicle of transposition vessels. Follow-up at 1 year after surgery, the patient's left upper limb had survived with limited movement and confirmed Flow-through the vessel reconstruction using CTA.
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Objective:To observe the effect that covering the nerve suture with CSPGs-gelatin sleeve after the sciatic nerve transection in SD rats, and evaluate its effect to improve nerve regeneration in peripheral nerve transection model.Methods:Covered and protected the sciatic nerve by end-to-end suture in the SD rats with CSPGs-gelatin sleeve. From July, 2019 to September, 2019, 24 SD rats were randomly and evenly divided into 3 groups, which were direct suture group, gelatin sleeve group without CSPGs (blank group), and CSPGs-gelatin sleeve group (CSPGs group). In each group, 3 rats were used to mark fluorescent gold at 5 weeks after operation. At 6 weeks after operation, histological and electrophysiological tests were performed to evaluate the tissue regeneration in the end to end suture and the effect of peripheral nerve regeneration after transection in the other 5 rats. One-way ANOVA was used for data analysis. If the difference between groups was statistically significant, LSD method would be further used for pairwise comparison. P<0.05 was considered statistically significant. Results:The escape distances in direct suture groups, blank group and CSPGs group groups were (787.19±213.77) μm, (547.17±167.71) μm and (350.60±68.58) μm, respectively; The numbers of the axons that grow into the distal basement membrane tube in 3 groups were (6 360±736.89) /mm 2, (8 040±673.05) /mm 2 and (9 000±644.20) /mm 2, respectively; The numbers of sensory nerve cells that were marked by fluorescent gold in the dorsal root ganglion were (124.35±25.88) /mm 2, (165.36±30.74) /mm 2 and (208.98±20.51) /mm 2 in 3 groups, respectively. The differences were significant compared with the CSPGs-gelatin sleeve group ( P<0.05). Thus, it led to a better nerve regeneration after transection in CSPGs-gelatin sleeve group according to the electrophysiological test and histological section observation of gastrocnemius muscles( P<0.05). Conclusion:CSPGs loaded in the gelatin sleeve can inhibit axons regeneration, and prevent the regenerated axons escaping from the end to end suture that may cause disorder axons regeneration or traumatic neuroma, and therefore improve the effective nerve regeneration after sciatic nerve injury in SD rat.
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The outbreak of COVID-19 around the world has made more than two millions of confirmed patients and serious shortages of healthcare resources and medical staff in many countries. In the battle of fighting COVID-19 in Wuhan, many microsurgery staff across China were sent to Wuhan and put on duty in the treatment of COVID-19 patients. The purpose of this article is to review the personal experiences of microsurgery staff in fighting against COVID-19 as well as to analyse how to act professionally when facing the challenges and change of roles and meanwhile having to give full play to the professional advantages subject to make contributions to the battle of COVID-19. A reference is hereby provided for the microsurgery staff in dealing with a sudden and major epidemic outbreak in the future.
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As continuous progressive improvement in microsurgery, the postoperative evaluation of severed limbs replantation has been developed from the survival to the functional recovery of replanted extremity. In 1978, Chen Zhongwei devised a system for the function evaluation of the replants, considering "the ability to work, range of motion, recovering of sensation, and recovering of muscle power". This system was called "CHEN’s criteria" and it is still internationally used. In recent years, new parameters and measuring methods have been created without an agreed international standard. This article serves the purpose to offer a reference in the standardization and promotion of a practical standard for the postoperative functional evaluation of severed limb replantation.
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In and from year 2020, we will work on an enthusiastic initiative: to make the Chinese Journal of Microsurgery a world leading sci-tech journal by executing our new mission "inheritance, innovation, unity, cooperation and internationalization" . Two special columns will be created: World Masters in Microsurgery and Pioneers of Microsurgery in China. We will start to compile a bilingual Bibliographic Index of Literatures in Microsurgery in China (Chinese and English), and publish a commemorative album which includes all the successive members of the editorial boards of the Chinese Journal of Microsurgery. A new academic and communicational forum will be established through a series of academic seminars held by the Chinese Journal of Microsurgery. In addition, we will start professional training programs for the surgeons and junior surgeons who work in the first-line of care in microsurgery, assist and enable them to participate international academic events and build/establish cooperation with their international counterparts. In line with international standards, we will apply bilingual titles and abstracts of articles in both Chinese and English, and add English interpretations/translations to all the references listed in Chinese. We will continue to keep our best work to make our journal being listed by the Medline hence to fulfil international involvement.
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It is difficult for peripheral nerves to achieve effective and orderly regeneration after injury for there are always mismatched, curly and disorderly newborn axons. Chondroitin sulfate proteoglycan (CSPGs), a kind of widespread extracellular matrix generally considered to inhibit peripheral nerve regeneration, may play an important role in promoting orderly regeneration of axons depending on its classification, physiological characteristics and spatial and temporal distribution as well. Complementing traditional modes of regenerating axons, its flexible applications may benefit biomimetic construction of peripheral nerve grafts that purely increase the number of axons and thus promote orderly and effective regeneration after peripheral nerve lesions.
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It is difficult for peripheral nerves to achieve effective and orderly regeneration after injury for there are always mismatched,curly and disorderly newborn axons.Chondroitin sulfate proteoglycan (CSPGs),a kind of widespread extracellular matrix generally considered to inhibit peripheral nerve regeneration,may play an important role in promoting orderly regeneration of axons depending on its classification,physiological characteristics and spatial and temporal distribution as well.Complementing traditional modes of regenerating axons,its flexible applications may benefit biomimetic construction of peripheral nerve grafts that purely increase the number of axons and thus promote orderly and effective regeneration after peripheral nerve lesions.
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Objective To explore the curative effect of anterolateral musculocutaneous flap to repair the soft defect of the lower leg amputation stump which on the verge of reamputation, and preserved the length of leg or the knee joint to improve prosthetic limb function. Methods Four patients with soft defect and bone expose of proxi-mal leg amputation stump were enrolled in this study from April, 2013 to November, 2016. Each patient underwent stump revision using anterolateral musculocutaneous flap, including 3 free musculocutaneous flaps and 1 pedicle mus-culocutaneous flap. The patients were all male with the mean age of 20(8-48) years. The wound was treated debride-ment, and reconstructed on the second stage. Defect area was from 7.0 cm×6.0 cm to 25.0 cm×10.0 cm. Anterolateral musculocutaneous flaps was from 13.0 cm×10.0 cm to 28.0 cm×12.0 cm. The length of preservation tibia stump was from 5.2 cm to 9.4 cm. Results All patients were followed-up from 12 months to 37 months (average, 19 months). All the musculocutaneous flaps survived completely with a soft tissue texture, elastic, and very wear-resisting. The sensory return was determined to be S2in 2 patients, S3in 1 patient and S3+ in 1 patient. The 6-Minute Walk Test:grade Ⅳ in 2 cases, grade Ⅲ in 2 cases; Stanmore movement classification: gradeV in 2 cases, grade Ⅳ in 2 cases. Conclusion The anterolateral musculocutaneous flap maybe is an ideal flap to provid stable coverage for the stump of leg amputation which on the verge of reamputation.
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Objective To investigate the short-term outcome of vascularized supraclavicular lymph nodes flap transplantation to treat the lower extremity lymphedema.Methods From June,2014 to June,2016,6 cases of stage Ⅱ-Ⅲ lower extremity lymphedema received vascularized supraclavicular lymph nodes flap transplantation in this study.Flap size ranged from 2.5 cm×8.0 cm to 3.5 cm×10.0 cm.The anterior tibial artery and accompanying vein were detached for anastomosis.Results One case suffered flap necrosis and then received lymphatic-venous anastomosis instead;2 cases suffered vascular crisis and partial flap necrosis,but transplanted lymph node survived and the wound were closed with skin graft.The other 3 flaps survived without any complication.Follow-up time ranged from 0.5 to 2.0 years.The affected limb circumference and the incidence of lymphangitis decreased significandy,with no complications observed in donor site.Conclusion Using vascularized supraclavicular lymph nodes flap transplantation to treat lower limb lymphedema,it has satisfactory short-term outcome and no obvious complications.It is a promising treatment choice for patients with lower extremity lymphedema in the early and mid stage.
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Objective To explore clinical value of intraoperative extra strong electrical stimulation in the treatment of birth brachial plexus palsy. MethodsFrom July 2008 to September 2011,intraoperative extra strong electrical stimulation was applied in 9 cases of incomplete birth brachial plexus palsy after neurolysis.The latency and amplitude of compound muscle action potentials before and after electrical stimulation were recorded and the extent of improvement was compare.ResultsThe latency was improved in 7 cases with 8.02％ in average,amplitude in 8 cases with 185.97％ in average.The related nerve recover partial motor function in 8 cases in 2 weeks after operation.ConclusionIntraoperative extra strong electrical stimulation is a effective assistant technique to promote motor functional recovery of birth brachial plexus palsy.
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Objective To provide vascular feature of neurocutaneous vascular flap and anatomical details about how to design the flap.Methods Ten fresh human body sample with twenty limb were perfused.The clinical anatomy of lateral antebrachial cutaneous nerve,medial antebrachial cutaneous nerve,sural nerve,superficial peroneal nerve,saphenous nerve and their nutrient vessels were studied.The distribution of their nutrient perforators were observed.Results Neurocutaneous nutrient vessels or nutrition artery with large diameter were accompanying nervus cutaneus by a long distance; Or longitudinal vascular chains were formed by ramus communicans with the ascending branches and descending branches from multiple segmental vessels.Medial antebrachial cutaneous nerve,lateral antebrachial cutaneous nerve,sural nerve,superficial peroneal nerve,saphenous nerve has the ulnar artery perforating branches,radial artery perforating branches,anteriolateral supra malleolar perforating branches,posterolateral supra malleolar perforating branches,medial supra malleolar perforating branches,accompanied separately,and the occurrence rate were 100％,95％,80％,90％,100％ respectively.Conclusion Cutaneous branch from the main deep artery is the anatomical basis of neurocutaneous nutrient vessel.Its distribution also accord to pressure balance rule.Mostly nervus cutaneus had constant perforator attending to suply its nutrition.Actually neurocutaneous nutrient vessel is a predictable and reliable vascular chain.
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Objective To observe the clinical therapial value of functional reconstruction with Botulinum Toxin A (BTA) on spasitic cerebral palsy. Methods Thirty-two patients were treated by Achilles tendon lengthening and anterior transfer of posterior tibial tendon.According to the spasticity of triceps surae muscle,all cases were arranged by BTA injection 2 months later after operation.Results From Jan.2000 to Jan.2009,thirty-two cases with equinovarus foot of spasticitical cerebral palsy were collected,the muscle strength of ankle dorsal extensor increased from 0-2 grades to 4-5 grades,there was significant difference between preoperational muscle strength and postoperational one.There was also significant improvement to adjust yarus degrees of ankle joint.the musclar tension of triceps muscle of calf decreased from Ⅱ-Ⅳ grades to Ⅰ-Ⅱ grades. Conclusion Anterior transfer of posterior tibial tendon corresponding with Botulinum Toxin A injection not only release muscle spasticity but also improve dorsal extending strength of ankle joint.The clinical effect of these methods was reliable on cerebral palsy.
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Objective To discuss how to assess scientifically on the outcome of clinical application with peripheral nerve graft materials. Methods All Pubmed database from 1990 to 2010 were retrieved,and searched the English literatures about the application with peripheral nerve graft materials. The literatures consisted of original clinical research and review excluding animal experiments, repetitive research and irrelevant literatures. The clinical trials data of U.S. was also our target. The information about the safety and effectiveness of peripheral nerve graft materials and related statistical problems were discussed. Results Totally 1578 literatures were identified. Following reading titles and abstracts, we excluded some irrelevant articles. Finally 31 literatures and 2 issue of clinical research from clinical trial data of U.S. were included. After analysis on the literatures, we gained the following results: a remarkable degree of homogeneity among patients can be formed by setting the inclusion and exclusion criteria. For the assessment of proper digital nerve repair, Macknnon- Dellon evaluation is commonly applied, but for the composite nerve, BMRC evaluation is the main method and electromyography can be used as a secondary choice. The safety of peripheral nerve graft materials cannot be evaluated throughout one's life according to the current level of science and technology. It should be evaluated by long-term clinical observation. Randomized clinical trials with random grouping was a gold standard for clinical trials with a good balance and strong comparability. However, non-randomized controlled trials also have an important value. Conclusion It is impossible to make all affected factors homogeneity in a limited timespace conditions of clinical trial. However, we can try our best to keep factors homogeneity to maximum degree by setting the inclusion and exclusion criteria. The scientific assessment of outcome of peripheral nerve repair can be carried out with reasonable and internationally recognized nerve function evaluation methods, strict follow-up time and statistics programme meeting the clinical requirement.
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Objective To explore the clinical classification of the brachial plexus root injury in adult.MethodsAll 155 cases of adult brachial plexus root injury in the First Affiliated Hospital of Sun Yat-sen University,were collected and analyzed on their characteristic,operative methods,and clinical outcome so as to find the distribution and incidence of different type of brachial plexus root injury and set up the clinical classification of adult brachial plexus root injury.ResultsBrachial plexus root injuries in adult could be classified into three types and seven subtypes.Type A is upper brachial plexus root injury,including type AⅠ (C5,C6 completely avulsion or rupture injury,with/without phrenic nerve injury),type AⅡ (C5-C7 completely injury),and type AⅢ (C5-C7 completely injury accompanied with C8,T1 incompletely injury).Type B is lower brachial plexus root injury,including type BⅠ[ C8,T1 (with/without C7)completely injury ] and type BⅡ (C8,T1,C7 completely injury,accompanied with C5、6 incompletely injury).Type C is total brachial plexus root injury,including type CⅠ(C5-T1 completely root avulsion) and type CⅡ(C7-T1 root avulsion accompanied with C5、6 root or trunkrupture).For the cases of every type,u pper brachial plexus root injury type A have 86 cases,in which type AⅠ 6 cases,type AⅡ 27 cases and type AⅢ 53 cases; lower brachial plexus root injury type B have 6 cases,in which type BⅠ 2 cases and type BⅡ 4 cases; total brachial plexus root injury type C have 63 cases,in which type CⅠ 51 cases and type CⅡ 12 cases. ConclusionExcept the upper,lower,and total three types,brachial plexus root injuries in adult could be classified further into seven subtypes.The distribution of different type of adult brachial plexus root injury is overbalance:upper type A (55.5％) is more often seen,total type C(40.6％) followed and lower type B(3.9％) is the least seen.In upper brachial plexus root injury,type AⅢ(61.6％) is more often seen,type AⅡ(31.4％) followed and type AⅠ(7％) is less seen.
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Objective To investigate the quality of life on brachial plexus injury patients in crosssectional study method and acquire related data. To analysis the effect factors and try to study on the methods which help to improve the quality of life of these patients. To our knowledge, this is the first study that measures quality of life of the brachial plexus injury patients in China. Methods Research participants completed the Chinese version of the World Health Organization Quality of Life Assessment-Bref (WHOQOL-BREF) and the 5-items version of International Index of Erectile Dysfunction Questionnaire (IIEF-5) for male.Data were typed into computer and analyzed with SPSS version 13.0. Correlations between domain scores and hospital stay, age, and family monthly income variables were analyzed with Spearman non-parameter correlation analysis. Results Fifty-one valid questionnaires were retrieved. The average score of these patients in physical, psychological, environment domains were 11.47 ± 2.36, 12.37 ± 2.28 and 11.62 ± 2.22, respectively. They were significantly lower than the norm groups in national studies which were 15.8 ± 2.9, 14.3 ±2.5 and 13.2 ± 2.4 (P ＜ 0.01 ). The average score of IIEF-5 was ( 17.83 ± 4.65), significantly lower than the normal score of 22 (P ＜ 0.01 ). Significant correlation was found among physical domain and age(P ＜ 0.05),family monthly income (P ＜ 0.05) and IIEF-5 score(P ＜ 0.01). Psychological domain also has significant correlation with IIEF-5 score (P ＜ 0.05) and so does environment domain with family monthly income (P ＜0.05). Conclusion Brachial plexus injury patients showed a reduction in quality of life scores. Even though the physical aspect was the most affected, there is evidence that the psychological, environmental domains and erectile function remained far from the ideal conditions expected for the general population. The effect factors are complex and there still remain much work to do.
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Objective To assess the validity of PKH26 dye for labeling the bone marrow mesenchymal stem cells (BMSCs) and the feasibility of this method for tracing the seed cells of tissue engineering nerve in vivo. Methods BMSCs isolated from Wistar rat's bone marrow were labeled with the PKH26 dye, the marked validity was observed by the fluorescence microscopy and flow cytometer, the cellular vitality was de-tected by MTT, the differentiated abilities were tested by in vitro osteablastic and lipoblastic differentiation. After that, the labelld cells were micro-injected into the acellular nerve grafts(ANG) to build compound grafts and cultured for 3,5,7,14 days in vitro, then frozen sections were made respectively to observe the survival and migration of the implanted cells in ANG. Simultaneously, these compound grafts were used to bridge the 1.5 cm sciatic nerve defects of the Wistar rats, 1,4,6,8 weeks postoperation, the grafts were taken out and frozen section were made in order to observe the survival of the implanted stem cells in vivo inside the ANG. Results PKH26 dye was good for labelling the BMSCs, marked validity was higher than 95%. The cellular vitality and differentiated abilities were not affected compared with the unlabelled cells. Further more, BMSCs could adhere to the ANG, and suvive,magrate in vitro. In vivo, BMSCs was able to survive at least 8 weeks in the nerve regenerative microenvironment. Conclusion PKH26 dye could label the BMSCs effectively, and it's suitable for in vivo seed cells tracing in tissue engineering nerve model.
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Objective To relatively prolong the length of C7 nerve through microanatomical study and carry out direct anastomosis between the end of avulsed nerve and contralateral C7. Methods Fifteen cadaveric specimens and 30 sides of the adult brachial plexus was dissected. The C7 nerve was confirmed and measured by using electric vernier caliper. Parameters as follow: the length of C7 nerve from root to trunk; the length of C7 nerve from root to division(anterior and posterior division); transverse and longitudinal diameter of C7 nerve in root site, combination site between trunk and division, end site of anterior and posterior division. After dissected the nerve adventitia of binding site between division and cord and cut the distal end of anterior and posterior division, the length of C7 nerve from root to division (anterior and posterior division)was measured again. Results The measured result of the length C7 nerve: the length of C7 from root to trunk: (45.87 ± 10.43)mm; Before micro-dissected, the length of C7 from root to anterior division: (61.14 ±13.44)mm; the length of C7 from root to posterior division: (54.63 ± 11.35)mm after micro-dissected, the length of C7 from root to anterior division: (74.67±12.86)mm; the length of C7 from root to posterior division:(68.73± 11.86)mm; the prolonged length of anterior division: (13.15± 4.26)mm; the prolonged length of posterior division: (14.21 ± 6.98)mm. Conclusion Through dessecting the adventitia of binding site of division (anterior and posterior division) and cord of C7 nerve. The length of C7 nerve can be relatively prolonged.
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@#Objective To analyze five kinds of allogenic acellular peripheral nerve by different meth-ods and try to establish a standard method for preparing nerve materials. Methods Five kinds of nerve ma-terial prepared by different chemical extractions according to nowaday articles were examined by HE staining. Irmnunohistochemistry and protein ratio was studied by allogenic nerves by virtue of Kjeldahl method in order to know the efficiency of these methods in removal of SCs axons and integrality of the basilar membrane. Results Myelin sheath and cytoblast in group 2 that nerves were extracted by Triton X-100 and Sodium de-oxycholate consecutively twice were completely removed, which was well demonstrated in HE staining. Per-ineurium in red staining were arranged wave-like longitudinally, axons and myelin sheath were replaced by column-like spacing. Col I staining were positive in all groups, structure of basilar membrane became loose slightly in the first and second group, and the structure of the other groups were relatively regular. Group 1 and 2 were negative in S-100 staining. There was no difference between group 2 and group 1,3,4 and 5 in sheath removal demonstrated by TEM. Protein ratio in group 2 was the lowest in the measurement with Kjel-dahl method. Conclusion The method used in group 2 that nerves were extracted by Triton X-100 and Sodium deoxycholate consecutively twice was the best in allogenic acellular peripheral nerve preparations.
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Objective Investigate the toxicity of polylactic acid,polyglacolic acid and chitosan on peripheral nerves,so as to detect the polymers with good biocompatibility to fabricate the scaffold of tissue engineered nerve Method Fifteen Sprague Dawley rats were divided into 3 groups randomly;polylactic acid,polyglacolic acid and chitosan were implanted into the sciatic nerves respectively.7 weeks later,the nerves with polymers were harvested and inspected by macroscopy and light microscope. Results There was mild hypertrophy of fibrous connective tissue within the nerves in each group.However,the nerve fibers were intact The polymers were surrounded by a pseudocapsule,and lymphocytes and macrophages infiltrated.The pseudocapsule coating chitosan was the thickest. Conclusion polylactic acid, polyglacolic acid and chitosan have no toxic effect on peripheral nerves.