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Objective:To analyze the feasibility of applying transcutaneous electrical nerve stimulator and high-frequency ultrasound in superficial nerve positioning for detection anatomical location in the area of lateral lip of the iliac crest by lateral cutaneous branch of subcostal nerve(LCSN). The significance of using the nerve as a free sensory superficial circumflex iliac artery perforator flap was discussed.Methods:The data of patients who underwent the repair of defects on limbs with free perforator flap or composite flap of superficial iliac circumflex artery carrying sensory nerve and the volunteers who agreed to have the location of the LCSN measured between October, 2018 and October, 2020 were collected. The LCSN were located by percutaneous electrical nerve stimulation and ultrasound, and the patients were measured and located during surgery. Using Passing-Bablok regression and Bland-Altman graph to evaluated the consistency between transcutaneous electrical nerve stimulation, ultrasound and the surgical positioning.Results:A total of 43 subjects, including 22 patients and 21 volunteers, were selected for locating the LCSN. Thirty-nine males and 4 females, with an average age of 39 years old and an average BMI of 24.08. The operation time of percutaneous nerve electrical stimulation was(6±1) min, and the detection distance was(80.7±5.9) mm. The high-frequency ultrasound was(23±4) min, and the distance was(81.2± 6.6) mm. The average operation time of surgical measured distance was(80.9±8.2)(65-100) mm, the diameter of nerve was(2.3±0.8)(1.0-4.0) mm, and the operation time was(5±1) min. A 95% CI of Passing-Bablok regression intercept and slope of operation, percutaneous electrical nerve stimulation and ultrasoundincluded 0 and 1, respectively. The points on Bland-Altman plot were distributed on both sides, and 95% CI of total mean difference, total intercept and slope included 0. Therefore, it was can be considered that the application of percutaneous electrical nerve stimulation and ultrasound in LCSN localization has good consistency.Conclusion:The location point of the LCSN crossing the iliac crest which detected by transcutaneous electrical nerve stimulation and high-frequency ultrasound detection was close to the measurement taken during the operation. It was also showed that both of them can be used for preoperative locationing of the sensory branch of the sensory nerve flap, optimizing the design of the flap, shortening the operation time, and reducing the unnecessary injury in operation.
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Objective:To investigate the efficacy of free thin sensate superficial circumflex iliac artery perforator flap based on lateral cutaneous branch of the subcostal nerve for repair of soft tissue defect in the foot and ankle.Methods:A retrospective case series study was made on clinical data of 9 patients with soft tissue defect in the foot and ankle admitted to 80th Group Military Hospital from December 2017 to December 2019. There were 8 males and 1 females, with the age of 28-63 years [(47.3±12.3)years] and the body mass index (BMI) of 16.7-27.8 kg/m 2 [(23.9±3.9)kg/m 2]. The size of soft tissue defect ranged from 10 cm×6 cm to 20 cm×12 cm. All patients were treated with the free thin sensate superficial circumflex iliac artery perforator flap based on lateral cutaneous branch of the subcostal nerve. After debridement or tumor resection, a thin sensate flap was harvested by intra-adipose tissue dissection between the superficial and deep fat layers. The size of flap ranged from 13 cm×8 cm and 13 cm×10 cm. The thickness of the defatted flap ranged from 3-6 mm. The distance from the anterosuperior iliac spine to the point where the lateral cutaneous branch of the subcostal nerve crossed the iliac crest ranged from 7.5-10.0 cm. The flap survival, complications, and reoperation were observed after operation. The sensory recovery of the flap was evaluated using Tinel sign and nine-grid method including monofilament touch perception, vibration perception, pinprick perception, temperature perception, and static two-point discrimination test. The joint range of motion, and shoewear and walking problems were recorded. At the last follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to assess the affected foot and ankle. The injury at the donor site was detected as well. Results:All patients were followed up for 6-35 months [(21.1±10.1)months]. All flaps survived without infection or tumor reoccurrence. One patient developed ulceration, then surplus skin on the reconstructed heel was resected. One patient underwent flap debulking and removal of internal fixation. One or more sensory modalities within the nine areas in each flap could be detected at postoperative 3-6 months. The monofilament touch, vibration, pinprick, and temperature perception were presented in almost all regions of each flap at postoperative 12 months. However, only one patient in one region was noted with the static two-point discrimination, in which the distance of the two points was set as 25 mm. The range of ankle motion was slightly limited in 2 patients who underwent osseoligamentous complex reconstruction. All patients were able to wear normal shoes and walk without pain. At the last follow-up, the AOFAS ankle-hindfoot score ranged from 78 to 97 points [(86.4±7.4)points], significantly improved from preoperative 10-70 points [(44.2±18.4)points] ( P<0.01). No patients complained of pain at the donor site, but the widening linear scar was noted. Conclusion:For medium-sized soft tissue defect of the foot and ankle, the free thin sensate superficial circumflex iliac artery perforator flap based on lateral cutaneous branch of the subcostal nerve can be defatted with the requirement and has advantages in defect site appearance, sensory restoration, wearing ordinary shoes, painless walking, good functional recovery, and minimal donor site morbidity.
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Objective To explore the dynamic changes of serum monocyte chemoattractant protein-1 (MCP-1) and interleukin-6 (IL-6) in patients with acute pancreatitis (AP) and its clinical significance.Methods A total of 103patients with AP admitted to our hospital from June 2016to December 2017were selected, which were divided into mild AP (MAP group, n=62) and severe AP (SAP group, n=41) according to the condition of disease.The levels of serum MCP-1and IL-6at 1st, 3rd, 7th day after admission were determined by the radioimmunoassay.At the same time, a total of 40healthy volunteers as control group were randomly selected.The predictive value of serum MCP-1and IL-6on for AP was analyzed.Results The serum MCP-1, IL-6level and APACHEⅡscore of MAP group and SAP group at 1st day were higher than those of control group (P<0.05) .The serum MCP-1, IL-6level and APACHEⅡscore of MAP group and SAP group at 3rd, 7th day were higher than those at 1st, and which at 7th were lower than those at 3rd (P<0.05) .The serum MCP-1, IL-6level and APACHEⅡscore of SAP group at 1st, 3rd, 7th were higher than those of MAP group (P<0.05) .Among patients with AP, serum MCP-1and IL-6were positively associated with APACHEⅡscore (P<0.05) .The best cutoff value of serum MCP-1for AP was 31.6pg/mL, and the area under ROC curve was 0.852, and the sensitivity and specificity was 0.87and 0.82respectively, and the accuracy was 0.85.The best cutoff value of serum IL-6for AP was 35.9ng/L, and the area under ROC curve was 0.876, and the sensitivity and specificity were 0.91and 0.85respectively, and the accuracy was 0.87.Conclusion The serum MCP-1and IL-6of patients with AP abnormal changes, which were closely related to the severity and prognosis.Early detection of MCP-1and IL-6can help to judge condition and evaluate prognosis.
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Objective To investigate the application and clinical outcomes of anterolateral thigh perforator flap bridging different superficial circumflex iliac artery flaps for the treatment of complex limb wound.Methods Data of 10 patients,who had undergone free tissue transfer of anterolateral thigh perforator flap bridging different superficial circumflex iliac artery flaps (iliac osteocutaneous flap,iliac crest flap and ilioinguinal flap) for the complex limb wound from March 2009 to January 2011,were retrospectively analyzed.There were 9 males and 1 female,aged from 21 to 57 years (average,39.7 years).Iliac osteocutaneous flap was used in 7 patients,iliac crest flap in 2 patients and ilioinguinal flap in 1 patient.The free tissue transfer was performed for hand reconstruction in 3 cases,foot reconstruction in 4 cases and leg reconstruction in 3 cases.The mean size of soft tissue defect was 20 cm × 9.7 cm.Results The mean size of the anterolateral thigh flap and the ilioinguinal flap was 17.8 cm×9.4 cm and 8.4 cm×4.5 cm,respectively.The mean volume of iliac crest was 5.4 cm×2.1 cm×0.8 cm,and the mean length of flow-through conduit was 10.5 cm.Except for the distal necrosis of iliac osteocutaneous flap in 1 case,which were treated by dressing change and skin grafting,the other flaps survived without complications.All patients were followed up for 6 to 36 months (average,12 months).The average bone union time was 3 months in the hand group,4 months in the foot group,and 4.5 months in the leg group.The disabilities of the arm,shoulder,and hand questionnaire score averaged 43,the mean Japanese Orthopaedic Association's foot rating scale was 71.3,and the mean Puno's functional score was 91.Donor site scars were mostly flat,pale and soft but widened in the thigh in 6 patients and in the ilioinguinal region in 3 patients,and numbness was reported in 2 patients.Conclusion In clinical situation that requires for coverage of complex and extensive limb defects,the free tissue transfer of anterolateral thigh perforator flap bridging superficial circumflex iliac artery flap is a better method,which can meet specific reconstructive demands with minimal donor site morbidity.However,a relative high risk has to be considered.
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Objective To evaluate free or pedicled perforator flaps for repairing chronic osteemylitis with soft-tissue defect in the distal lower extremity. Methods From May of 2006 to October of 2007, 28 consecutive patients of chronic osteomylitis with soft-tissue defect in the distal lower extremity underwent surgical debridement and reconstruction with free or pedicled perforator flaps. There were 13 free flaps. The free anterolateral thigh flaps were used in 2 cases to repair the soft defects in the front of leg, 3 cases in the front of the malleolus, 2 cases in the dorsum of foot, 2 cases in the heel. The free lateral crural flaps nourished by perone al artery were used in 4 cases to repair the soft defects in the dorsum of foot. There were 15 pedicled flaps. Posterior tibial artery perforator flaps were used in 4 cases to repair the soft defects in the front of leg, and 2 cases in the medial malleolus. Lateral retromalleolar perforator flaps nourished by peroneal artery were used in 6 cases to repair the soft-defects in the heel, 1 case in the lateral malleolus and 1 case in the dorsum of foot, the first dorsal metatarsal artery perforator flap was used to repair the proximal dorsum of hallux. The wound was closed with irrigation-suction in 7 cases and with vancomycin-impregnated gelatin in 8 cases. Results All 27 flaps were successfully survived except insuffcient vein refluence in 1 posterior tibial artery perforator flap, which resulted in a superficial necrosis and healed spontaneously. The follow-up period from 6 months to 2 years revealed that recurrence developed in two diffuse type patients and both were treated once and twice with success, respectively. The others healed without any signs of recurrences. No debulking procedure was necessary in any case. Secondary bone graft was performed in 3 cases. All patients were ambulatory and fully weight-bearing with normal clinical parameters at the time of last review. According to the evaluating criteria for the treatment of foot disease, the mean score was 84.5. Conclusion Free or pedicled perforator flap has been shown to be well vascularised, and it is feasible for the treatment of chronic osteomyelitis with soft-tissue defect in the distal lower extremity.
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[Objective] To investigate the influence of Chitosan fiber combined with gelatin on the mechanical property of calcium phosphate cement.[Methods]Calcium phosphate cement composite by the incorporation of chitosan fiber and 5 wt% gelatin was investigated on flexural strength,phase composition,scanning electron microscopy observation and cytotoxicity assays.[Results]Fiber volume fraction had a significant effect on the flexural strength,and the post hoc test revealed that significant difference in the flexural strength was recognized(P
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Angiogenesis plays an important role in the process of the repair and regrowth of tissues. So far, many growth factors have been shown to have the angiogenic properties. Angiogenesis therapy using exogenous angiogens or the DNA coding for these growth factors has aroused extensive interest. The advances concerning angiogens and angiogenesis therapy applied in reconstructive surgery are reviewed in this paper.
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Objective To study and discuss the methods for repairation and reconstruction of foot defects in order to reduce the deformity and insufficiency of foot and to restorat its functional and cosmetic aspects. Mehtods Soft tissue recovery was enough for digital absence, dorsal, submalleolus and calcaneous defect; Delects in plantar should be repaired with pre flap; Abstence of metatarsats head should be reconstructed by using vascularized bone incorporation with free flap transplantation. Results Total 247 cases with bone and soft tissue defects of foot were recpaired by using managements mentioned above aehived satisfactory clinical result. All patiants were assed according to AOFAS of USA fool malleolus scores, excellent 84 cases; good 107; fair 42; poor 14. Conclusion Being flat in shape and abundant blood supply, the iliac bone is a valuable supply bone lor foot defects espesial for muti-matatarsal and ealeaneus. Absence of malleous should be reconstructed by free iliac bone or free febular head with fascial strip. Vascular bone incorporating with vascular flaps provided an ideal method of reconstruction foot conpound defeets.
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Objective To investigate the characteristics, degradation and biocompatibility of a woven chitosan fiber (CF). Methods Scanning electron microscopic observation, deteronination of density, degree of swelling and tensile strength were performed to characterize the CF. In vitro degradation was observed by immersing CF in buffered aqueous solution of pH 6 containing lysozyme at 37 ℃, while in vivo degradation was studied after intramuscular implantation of CF in rats. Furthermore, rat mesenchymal stem cells were directly cultured on CF to estimate its toxicity. Results The diameter of CF was about 2000?63?m, with a sleek surface. The density and rate of swelling were 1.093?0.27g/cm3 and 2.30?0.21, respectively. The tensile strength was 80.18?1.56MPa. Specific viscosity, measured after the addition of lysozyme to the solution, decreased dramatically within 2 hours compared with that of the control mixture without enzyme. There was obvious inflammatory reaction after intramuscular implantation in the first week after surgery, bat inflammation subsided gradually. Biodegradation was not obvious within 4 weeks, but majority of it was absorbed in twelve weeks. Cells grew well on it with normal morphology, and no inhibition of cell proliferation could be observed. Conclusion Woven CF has a good tensile strength and fairly good biodegradation and biocompatibility, and it can be used in bone and cartilage tissue engineering.