Clinical application of Reading man flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Reading man flap for the closure of round or elliptical-shaped defect.</p><p><b>METHODS</b>Based on the asymmetric Z flaps, F1 (triangular flap) and F2 (rectangular flap) flaps were designed to cover the round or elliptical-shaped defects. The flaps size ranged from 0.8 cm x 0.8 cm to 9.0 cm x 8.0 cm.</p><p><b>RESULTS</b>From 2008 to 2011, 32 cases were treated without infection or dog-ear deformity. Less than 5% of local necrosis happened in one flap, which healed spontaneously after dressing. Delayed healing happened in 5 cases. The scar after operation was inconspicuous.</p><p><b>CONCLUSIONS</b>Reading man flap can be designed flexibly. It is a good option for the closure of round or elliptical-shaped defects.</p>

MAFbx and MuRF1 mRNA expression and its relationship with muscular contractility following free muscle transfer / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study muscle atrophy F-box (MAFbx) and muscle ring finger 1 (MuRF1) mRNA expression and its relationship with muscular contraction following free muscle transfer.</p><p><b>METHODS</b>The gracilis muscle was orthotopic transferred in adult rat to establish the animal model. The muscle at the unoperated side was used as control. The expression of MAFbx and MuRF1 mRNA, the muscle contraction and muscle function were measured by real-time PCR and multiple function physiological device. The relationship among the expression of MAFbx and MuRF1 mRNA, the muscle contraction and muscle function was analyzed.</p><p><b>RESULTS</b>After muscle free transfer, muscle wet weight reservation, the maximum contraction and tetanus strength reduce first and increased later, but still lower than those at control side. The expression of MAFbx and MuRF1 mRNA reached peak level 3 - 4 weeks after muscle transfer which was 7.1 and 4.1 times as that at control side. It decreased later, but still higher than that at control side, showing a significant difference between them (P< 0. 05).</p><p><b>CONCLUSIONS</b>Persistent over-expression of MAFbx and MuRF1 mRNA after muscle transfer has a close relationship with muscle atrophy and muscle dysfunction. MAFbx and MuRF1 can be used as markers for early muscle atrophy, and also as potential target for drug treatment of muscle atrophy.</p>

Anatomic study of intramuscular nerve and blood vessel in forearm muscles: an anatomical study / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the distribution of intramuscular nerve and blood vessels in forearm muscles and to discuss the possibility of dividing the forearm muscles into independent functional units.</p><p><b>METHODS</b>(1) The muscles were dissected in 10 forearms from 5 fresh adult human cadavers and stained with the Sihler's nerve staining; (2) The blood vessels were studied in eight forearm muscles from 4 fresh adult human cadavers with irrigation of a mixture of 30% barium sulfate and gelatin from brachial artery and then X-photographed. All pictures were compared to study the intramuscular distribution of nerve and blood vessels.</p><p><b>RESULTS</b>The intramuscular nerve branches were stained purple-black and visualized clearly. The muscles were classified into three types according to the distribution characters of intramuscular nerve and blood vessels. And the types of muscles could be further subdivided into a and b subtypes.</p><p><b>CONCLUSION</b>According to the neurovascular distribution, the forearm muscles in type II a and type III a can be divided into independent function units for muscle functional transplantation.</p>

Anatomy of buccal and marginal mandibular branches of facial nerve and its clinical significance / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the course and distribution of buccal and marginal mandibular branches of facial nerve, and its relevance to the treatment of facial paralysis and the protection of facial nerve during surgery.</p><p><b>METHODS</b>12 cadaver heads were dissected (24 specimens). The course of the buccal and marginal mandibular branch and the interconnections between them were observed. The relationship of buccal branch to parotid duct, marginal mandibular branch to the inferior border of mandible were studied. With modified Sihler's staining technique, the distribution of facial nerve branches in innervated mimetic muscles was displayed. These anatomic relationships mentioned above were further confirmed during the operation of 40 patients with facial paralysis.</p><p><b>RESULTS</b>Parotid duct had a constant surface landmark. Buccal branch mainly consisted of 2-3 ramifications in 87.5% of the specimens, while marginal mandibular branch was double or single in 95.9% of the specimens. The buccal branch coursed within the distance between 10.7 mm above and 9.3 mm below the parotid duct, and innervated mimetic muscles of midface. The marginal mandibular branch coursed within the distance between 13.4 mm above and 4.8 mm below the lower border of mandible, crossed superiorly the facial artery and innervated mimetic muscles of lower lip.</p><p><b>CONCLUSIONS</b>There is a close relationship of buccal branch to parotid duct and marginal mandibular branch to facial artery and lower border of mandible. With modified Sihler's staining technique, the original 3-dimensional picture of the intramuscular nerve distribution in human mimetic muscles.</p>

Laparoscopic small intestinal flap colpopoiesis / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the possibility of Laparoscopic reconstruction of vagina using pedicled ileal autograft and provide a new procedure of colpopoiesis.</p><p><b>METHODS</b>The abdominal and perineal approaches were performed simultaneously under a sufficiently deep general anaesthesia. Laparoscopically, a 15-18 cm segment of the ileum on its vascular pedicle, ileal branches of the superior mesenteric artery and its concomitant veins, was selected and isolated for transplantation using ultrasonically-powered instruments. The distal of the transferred ileal segment was 15cm apart from the ileocecal junction. The ileum continuity was restored immediately by end-to-end anastomosis and the distal oral of the transplant was closed using a curved intraluminal stapler. Meanwhile, a neovaginal tract was completed to dissect from the perineum into the peritoneum and the tract widened laterally. Then the ileum transplant was reversed to reach the perineum through the peritoneal incision at the top of the neovaginal tract without subjecting the mesenteric neurovascular pedicle to undue tension and subsequent necrosis. The oral edge of the ileum transplant was sutured to the perineal skin.</p><p><b>RESULTS</b>Followed up for over 1-53 months postoperatively, 36 patients who received laparoscopic vaginoplasty by transferring ileal segment flaps got satisfactory neovaginal function similar to a normal vagina with mucus and moistness.</p><p><b>CONCLUSIONS</b>The advantages of using a laparoscopic ileum colpopoiesis are that (1) satisfactory neovaginal function similar to a normal vagina with mucus and moistness, (2) no disturbance of bowel function, (minimal scarring in abdominal wall and less secondary deformity in perineum and (3) no need for frequent dilation or stent wearing to the reconstructed vagina. And so laparoscopic vaginoplasty was a preferable alternative of vaginoplasty.</p>

The neuromuscular compartments of the flexor carpi ulnaris and the flexor carpi radialis / 中华整形外科杂志

<p><b>OBJECTIVE</b>Report on the intramuscular innervation and vascular supply of the flexor carpi ulnaris (FCU) and the flexor carpi radialis (FCR), the musculo tendon architecture, i.e., the physiological cross-sectional area and fiber length; and explore the possibility of splitting FCU and FCR into 2 parts with individual independent function.</p><p><b>METHODS</b>Anatomic study, angiogram and Sibler's staining technique were carried on human and monkey cadavers. The electric stimulation study was used to reveal independent contraction of each part on monkey FCU and FCR.</p><p><b>RESULTS</b>It was found that the innervation and blood supply of FCU and FCR come primarily from the proximal neurovascular pedicles. The primary nerve and vascular branch supplying the muscles were divided into 2 subbranches and inserted the proximal quarter of the muscle belly. Then each of the nerve and blood subbranches mn parallel to the central tendon on each side supplying the radial and ulnar compartments of FCU and FCR toward the distal musculotendinous junction. Independence of function of each compartment was confirmed in electrical stimulation studies in primate FCU and FCR. The results of each compartment of the human FCU and FCR architectures were measured and compared with the extensor pollicis longus and the extensor digitorum communis to the index, middle, ring, and small.</p><p><b>CONCLUSIONS</b>Both FCU and FCR can be split from the distal to the proximal along its tendon into 2 independently functioning neuromuscular compartments. Both radial compartment and ulnar compartment have its own nerve and adequate blood supply. And the study provides useful information for enabling the local transfer of the two muscles as a whole or two separate compartments, both for resurfacing skin soft-tissue defects and for functional tendon transfer.</p>