ABSTRACT
Objective To investigate the clinical efficacy of using the tissue engineering bone loaded with adipose derived stem cells (ADSCs)and perforator flap in the treatment of composite tissue defects.Methods From April,2013 to June,2015,there were 9 cases of traumatic bone and skin composite tissue defects,including 7 males and 2 females,with an averaged age of 43 years old.The ADSCs were isolated,induced and co-cultured with demineralized bone scaffold.The tissue engineering bone and deep inferior epigastric artery perforator (DIEP) flap were adopted for reconstruction of composite tissue defects.Results All 9 patients were followed up for 12-36 months,averaged of 18 months.The bone growth was obviously for 5 cases with bone defects at the middle and lower part of the tibia.They tolerated full weight bearing walking.One case of middle humeral bone defect demonstrated normal bone tissue growth,and the 2/3 of cross section had been restored.One case of humeral bone defect and 1 case of radial bone defect reached bone union.The remaining 1 with skull defect showed new bone growth,but it had not yet achieved complete bone healing.Conclusion The combination of tissue engineering bone and perforator flap is a minimally invasive,easy accessible and effective method for reconstruction of composite tissue defects.
ABSTRACT
Objective To investigate the reliability and effect of using the chimeric flap retrieved by laparoscopic surgery to cover the large defect of the extremities.Methods The debridement and vacuum sealing drainage (VSD) were performed on 18 patients, who were admitted due to the defects of the extremities.The free chimeric peritoneal-deep inferior epigastric artery perforator (DIEP) flap assisted by laparoscopic surgery was transplanted to cover the defect with exposed tendons and/or skeleton.Results The remaining defects of the extremities were 12 cm × 8 cm-30 cm × 17 cm.The peritoneal component of the chimeric flaps measuring 8 cm × 6 cm -14 cm × 10 cm retrieved by laparoscopic surgery was used to cover the tendons, bones and joints.The deep inferior epigastric artery perforator (DIEP) flaps measuring 13 cm × 10 cm-32 cm × 18 cm allowed the cutaneous coverage of wounds.The chimeric flaps survived completely excepting two patients.The two patients experienced partial necrosis of the chimeric flaps and received skin grafting to achieve the wound closure.The function of the injured extremities recovered partially after 6-18 months of follow-up.No abdominal pain, distension, herniation,bulging and intestinal obstruction were recorded.Conclusion The chimeric flap assisted by laparoscopy is a helpful, safe and effective method for reconstruction of large wounds in extremities with exposed tendons and bones.
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Objective To investigate the efficacy of using the extensor carpi ulnaris as the motor tendon in correcting claw hand deformity and improving hand function.Methods A total of 12 patients with ulnar nerve palsy and claw finger deformity were included into this study from October, 2009 to September, 2011.Results All ceses had an average followed-up of 15.5 months, ranging from 12 months to 24 months.According to the Total Active Movement (TAM) score, there were 4 cases receiving excellent results, 6 cases receiving good results and 2 cases receiving fair results.The claw finger deformity was corrected and intrinsic hand function improved significantly.The average increase in grip strength was 41％ at the 12 months post operation, compared with the preoperative data (P ＜ 0.05).The mean DASH score decreased from 53.6 ± 11.4 preoperatively to 20.4 ± 6.8 postoperatively (P ＜ 0.05).Conclusion The technique of using the extensor carpi ulnaris as the motor tendon is effective in correcting claw fingers, increasing the grip strength and improving overall hand function.This surgical procedure is also beneficial for patients accompanied by the median nerve injury.
ABSTRACT
Objective In attempt to improve the reconstruction of small defects in the facial and frontal regions, we developed a modified radial artery perforator-based free flap. Methods The free proxi-mal radial forearm flap was based on the distal perforator of the radial artery and the concomitant radial vein. The vascular pedicle passed through deep fascia. The free flap was transferred to repair the defects of the fa-cial and frontal regions. Results In 6 patients with frontal defects and 4 patients with facial defects, all flaps survived completely. After following up for 6-12 months, flaps underwent plastic surgery to become thin-ner. The flaps of 10 cases were good in skin texture and color at recipient sites. The scars were cosmetically acceptable. The superficial sensibility recovered well. Conclusion A modified radial artery perforator-based free flap was useful in coveting small defects of the facial and frontal regions.