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Objective To explore the clinical effect of the radial artery perforator flap on repairing soft tissue defect after palm postoperative scar contracture. Methods Eighteen patients with palm scar contracture were selected. The palm soft tissue defect was repaired by radial artery perforator flap after the operation of scar removal and soft tissue release. The areas of soft tissue ranged from 5 cm × 3 cm to 8 cm × 5 cm. The area of donor flap exceeds 20%of the wounds area, and wounds were repaired by free skin grafting. Six months after operation, the hand function was compared with that before operation. Results All the patients were followed up for 6-15 months (mean 10.8 months), all flaps survived with good shape, and flap donor site wounds were healed by skin grafting. The patients were evaluated 6 months after operation according to the Chinese Medical Hand Surgery Society of upper part of functional assessment criteria: excellent in 11 cases, good in 5 cases and general in 2 cases, but preoperative functional evaluation was excellent 0 case, good in 3 cases, general in 7 cases and poor in 8 cases. Compared with that before operation, the postoperative function was significantly improved. Conclusions It is a commendable approach of repairing soft tissue defect after postoperative palm scar contracture by radial artery perforator flap, because it can provide reliable blood supply, and significantly improve hand function with exactly clinical effect.
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Objective To prepare nerve growth factor gradient release system,and explore the promotion of the clinical effects of peripheral nerve regeneration.Methods All 57 cases with peripheral nerve injuries were treated with emergency nerve repair from July 2010 to August 2012,a nerve repair,with meanwhile randomly were divided into group A (19 cases),group B (19 cases) and group C (19 cases).The NGF was used to partial release by using the homemade gradient release system in group A,the same amount of NGF was partial injeced to Gelatin sponge surrounding peripheral nerve in group B.The NGF wasn't injected in group C.All patients respectively underwent neurophysiological examination after 4 weeks and 8 weeks.Comparising with the somatosensory evoked potentials (SEP) and muscle action potential (MAP) between different groups,meanwhile analyzing nerve conduction velocity (NCV).The sensory and motor function evaluation score of BMRC were performed after 24 weeks.Results The peak latency of the SEP after 4 weeks in A,B and C groups were (34.80 ± 3.45) ms,(42.85 ± 2.58) ms,and (51.05 ±3.652) ms,respectively; the volatility were (10.673 ± 2.35) μV,(6.30 ± 1.22) μV,and (4.10 ±0.83) μV,the peak latency of the MAP after 4 weeks in A,B,C groups were(5.29 ±0.82) ms,(7.63 ± 1.35)ms,and (9.98 ± 1.15) ms,the volatility were (485.75 ±65.83) μV,(262.510 ±59.90) μV,and (185.64 ±38.35) μV,the NCV were (25.50 ±3.65) m/s,(19.80±2.35) m/s,and (15.50 ±2.61) m/s.The peak latency of the SEP after 8 weeks in A,B,C groups were (24.68 ±4.50) ms,(31.08 ±4.24) ms,and (39.25 ±4.83) ms,the volatility were (21.22 ± 4.63) μV,(13.68 ± 4.14) μV,and (8.90 ± 1.25) μV.The peak latency of the MAP after 8 weeks in A,B,C groups were (4.71 ±0.35) ms,(6.10±1.54) ms,and (8.86±0.75) ms,the volatility were (839.81 ± 111.07) μv,(512.25 ±46.82) μv,and (312.65 ±47.52) μv,the NCV were (26.24±3.22) m/s,(21.23 ±2.40) m/s,and (16.34 ±2.55) m/s.Compared with the group C,the peak latency of the SEP,MAP was shortened significantly and the Volatility was increased significantly in group A and B,the NCV was faster significantly in group A and B (P ＜ 0.05).Compared with the group B,the peak latency of the SEP,MAP was shortened significantly and the Volatility was increased significantly in group A,the NCV was faster significantly in group A (P ＜ 0.05).The good rate of the A,B,C groups in BMRC sensory function score were 78.95％,63.15％ and 52.63％ respectively.The good rate in BMRC motor function score were 84.21％,68.42％and 47.37％ respectively.The group A and B were higher than group C,and the good rate of group A was higher than group B(P ＜ 0.05).Conclusion The nerve growth factor gradient release system is safe and effective for early treatment of peripheral nerve injuries.
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Objective To discuss the effect of the sustained releasing agent FK506 on the ultrastructure of the regenerative nerve fibers.Methods The new fusiform-shaped double channel nerve conduit was used for bridge the sciatic nerve defects for 10 mm in 32 Sprague-Dawley rats.The rats were divided into Group A(100μl chitin for both channels)and Group B(chitin plus FK506 for B1 and chitin plus normal saline for B2)according to different addition of the drugs.At 8 and 12 week after operation,the middle line of the regenerated nerve was observed under the transmission electron microscope.In the meantime,an analysis was done on the area of the regenerated nerve fibers(myelinated and unmyelinated),diameter and myelin thickness of the myelinated fiber axon at 8 and 16 months.Results There was not significant difference in aspects of type and number of the regenerative nerve fibers between two channels in Group A.However,the myelinated and unmyelinated fibers of the regenerative nerves were increased in Group B1,with larger area than Group B2(P ＜ 0.05).Conclusion FK506 can significantly promote the regeneration of both the myelinated and unmyelinated fibers.
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[Objective]To discuss the effects of angiogenesis about nerve growth factor(NGF) during the peripheral nerve regeneration.[Method]Thirty-six Sprague-Dawley rats with 10mm gap of sciatic nerve were randomly divided into two groups which had been bridged with the new double channel nerve conduit of fusiform shape.Each group contained eighteen animals,in the first group,200 ?l of chitin for medical use was injected into the conduit,in the second group,the two branches of the conduit contained 100 ?l of the chitin and 5 ?l NGF or ciliary neurotrophic factor(CNTF).At four,eight or sixteen week after operation,the angiogenesis of NGF was evaluated with Hematoxylin and Eosin(HE) staining and electron microscope.[Result]There were not significant differences of the regenerative nerve fibres between two channels in the first groups,but in the second group,the regenerative nerve of NGF branch channel was red,crisp and the nerve of CNTF branch channel was yellow and tenacious.HE staining showed that there were much more new vessel in the regernerative nerve tract of NGF the branch channel,and the regernerative nerve fibre was disorder,there were much more fibroblasts and vessels observed under eletron microscope.[Conclusion]NGF can significantly promote the angiogenesis during the peripheral nerve regeneration,the mechanism may be related to fibroblast.
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Objective To evaluate the diagnosis and treatment of chronic pancreatitis complicated by stricture and dilation of the pancreatic duct. Methods The clinical data of 27 patients of chronic pancreatitis with stricture and dilation of the pancreatic duct undergoing operation in our hospital from 1990 to 1999 were analyzed retrospectively. Results Of the 27 patients, the positive diagnosis rate was 89% by B-US, 100% by CT, 100% by MRCP, 100% by ERCP. All patients received surgical operation, 12 patients received Partington procedure, 3 distal pancreatectomy, 4 pylorus preserving pancreaticoduodenectomy, 4 Beger procedure, 2 Frey procedure, 2 pancreatic cystojejunostmy. The complication rate was 11%. Postoperatively 89%(24/27) patients achieved pain relief,78%(18/23) gained in body weight, and diabetes significantly relieved in 5 cases(33%). Conclusion Appropriate diagnosis and treatment are very important for improving the patients′ life quality and natural history of chronic pancreatitis with stricture and dilation of the pancreatic duct.