Functional evaluation of a "two in one" urethroplasty for hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To assess the functional result of a "Two in One" urethroplasty which combined oral mucosa graft and local flap.</p><p><b>METHODS</b>17 patients with hypospadias underwent a "Two in One" urethroplasty, which combined buccal mucosa and local flap for urethral reconstruction. Uroflowmetry was performed 1 day before and 1 year after operation. The urine flow rate, voided volume and urine flow curves were detected using a rotating sensor. The results of maximum urine flow rate (Qmax) were expressed as percentiles and compared to the Toguri value from normal children.</p><p><b>RESULTS</b>Before corrective operation, 12 of 17 patients (70.6%) produced a plateau urine flow curve. 5 patients (29.4%) produced a very low flow curve. The average maximum flow rate was (7.89 +/- 2.29) ml/s per second compared to Toguri values, 12 of 17 patients (70.6%) had a Qmax below the normal 5th percentile. After a "Two in One" urethroplasty, a hell-shaped curve was obtained in 10 patients (58.8%). The maximum flow rate was (11.30 +/- 3.01) mL/s per second. 7 of 17 patients (41.2%) had a Qmax above the normal 25th percentile, 8 patients (47.1%) had a Qmax between the normal 25th percentile and 5th percentile, only 2 patients (11.8%) had a Qmax below the 5th percentile.</p><p><b>CONCLUSIONS</b>The functional result of the "Two in One" urethroplasty is ideal. The maximum urine flow rate of the patients increases after the operation.</p>

Application of tunica vaginalis flap for multi-fistulas after urethroplasty in hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discussed a new technique for multi-fistulas after urethroplasty in hypospadias.</p><p><b>METHODS</b>8 cases with postoperative multi-fistulas, which were not successfully repaired by previous treatment, were reoperated with tunica vaginalis flap combined with urethral stent and elastic dressing. The multi-fistulas were located between glan and scrotum. The number of fistulas was 3-7 (median, 5).</p><p><b>RESULTS</b>Primary healing was achieved in all the 8 cases. The micturition and esthetic result were satisfied. 5 cases were followed up for 8-10 months with no recurrence of fistula. There was also no dysuria and penile curvature.</p><p><b>CONCLUSIONS</b>Tunica vaginalis flap combined with urethral stent and elastic dressing is an effective technique for multi-fistulas after urethroplasty. It is easily performed with reliable result.</p>

Tubed oral mucosa for staged treatment of congenital hypospadias in infancy / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discuss the treatment of congenital hypospadias in infancy.</p><p><b>METHODS</b>After correction of chordee, the tubed oral mucosa was used to prefabricate urethra in penis as free graft. The urethral anastomosis was performed at the second stage. The scrotum fascia flap, pedicled with scrotal artery, was transferred to cover the penile defect.</p><p><b>RESULTS</b>From Jan. 2007 to May 2010, 42 cases were treated. The tubed oral mucosa was 3.0-4.0 cm in length, and 0.6-0.8 cm in diameter. The maximum size of scrotum flap was 1.5 cm x 3.0 cm. Urethral fistula happened in two cases due to necrosis at the distal end of scrotal flap, which was healed spontaneously after dressing for 1-2 weeks. Primary healing was achieved in all the other cases. After operation, the 26 cases have been visited for 6 months to 3 years, no urethra fistula , narrow and the penis curved. There is an universal urinate for oneself and a good form.</p><p><b>CONCLUSIONS</b>The tubed oral mucosa can be used to prefabricate urethra, which is anastomosed at the second stage. The tubed oral mucosa combined with scrotal fascial flap which has a reliable blood supply, is very suitable for hypospadias in infancy.</p>

Effect of the botulinum toxin type A on myocutaneous flap expansion in minipigs model / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the histologic effect of botulinum toxin type A (Botox A) injection on myocutaneous flap expansion in minipigs model.</p><p><b>METHODS</b>Seven minipigs were included in this study. Two symmetric tattoo area, 10 cm x 6 cm in size, were selected on the bilateral flank of the pigs. The Botox A was injected into one tattoo area randomly, 4 U every point, 2 cm apart, with a total dose of 96 U. The same dose of sterile normal saline (0.9%) was injected in the same fashion on the opposite side as control. 3 days after injection , two 200 ml expanders were inserted beneath the cutaneous muscle at the tattoo area. After complete expansion of 200 ml, the specimens were drawn from both groups symmetrically and were stained by means of HE and Masson. The histologic changes of myocutaneous flap were compared. Thickness of each layer in myocutaneous flap was measured in histological section.</p><p><b>RESULTS</b>The thickness of cutaneous muscle, capsule, dermis were (275.74 +/- 28.93) microm, (468.03 +/- 34.28) microm, (1990.79 +/- 102.10) microm in Botox group, and (409.13 +/- 44.63) microm, (626.55 +/- 44.05) microm, (2508.44 +/- 70.71) microm in saline group, respectively, show a significant difference between the two groups (P < 0.01). The Masson stained slice showed that collagen average gray of capsule in Botox group was 185.38 +/- 9.56, which was significantly higher than that in the saline group (120.77 +/- 10.31, P < 0.01). Light microscope (HE stained sections ) showed that muscle in Botox group was significantly atrophy and cross-section of muscle fiber decreased. The muscle fiber in saline group was generally normal. It was observed through transmission electron microscope that the light and dark band of muscle cell became fuzzy and the Z line bending in Botox group. The light and dark band in saline group arranged neatly, the Z line was clear.</p><p><b>CONCLUSIONS</b>Application of Botox A in myocutaneous flap expansion can make the muscle atrophy and reduce the content of collagen in capsule layer, making the myocutaneous flap thinner which is suitable for reconstruction in face and neck.</p>

Application of tissue granule of oral mucous in plastic surgery / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the application of tissue granule of oral mucous in plastic surgery.</p><p><b>METHODS</b>Tissue granule of oral mucous was placed on glutin sponge and they were used for urethral (12 cases) and vaginal (14 cases) reconstruction in 26 cases.</p><p><b>RESULTS</b>Satisfactory results were achieved in 24 cases. One case of urethral fistula and one case of urethral meatus stricture were happened. The two cases underwent secondary operation.</p><p><b>CONCLUSIONS</b>Tissue granule of oral mucous membrane is good supply for repairing mucous defect. It has the advantages of high growth and survival rate, and less shrinkage. It is useful for urethral or vaginal reconstruction which are covered with mucous membrane.</p>

Staged treatment of the severe hypospadias in adult / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the treatment of serious hypospadias in adults with free graft of tubed mouth mucosa and scrotal fascia flaps.</p><p><b>METHODS</b>The tubed mouth mucosa was free grafted to fabricate the distal segment of urethra. It was anastomosed to the urethra at the second stage. The scrotal fascia flap was used to cover the penile wound. The biggest flap was 3 cm in width and 6.5 cm in length.</p><p><b>RESULTS</b>From Jan. 2002 to Dec. 2007, 76 adults with severe hypospadias were treated. Infection happened in 4 cases. 2 cases had urethral fistula due to the partial flap necrosis which was healed automatically within 2-4 weeks. All the other patients healed primarily.</p><p><b>CONCLUSIONS</b>It is a good method for the treatment of serious hypospadias in adults with scrotal fascia flaps and free graft of tubed mouth mucosa which is anastomosed to the urethra at the second stage.</p>

A rhombus shape excision of the soft palate to treat obstructive sleep apnea hypopnea syndrome / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a surgical treatment for obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>12 cases were treated during the period from Jan 1998 to Aug 2006. Partial soft palate was resected in rhombus shape from the middle to shorten the soft palate and enlarge the pharyngeal cavity. The uvula was reserved.</p><p><b>RESULTS</b>The patients were followed up for six months to five years. There was no complication. Good results were achieved in 9 patients. 2 cases got some kind of improvement. No improvement happened in one case who received a partial tongue resection later.</p><p><b>CONCLUSIONS</b>A rhombus shape excision of the soft palate from the middle is effective for the treatment of OSAHS with few complication.</p>

Division of the proximal urethral plate and skin graft at the ventral surface of the penis for severe hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a technique for the treatment of severe hypospadias.</p><p><b>METHODS</b>At the first stage, the proximal end of the urethra plate was divided and the chordee was corrected, followed by skin graft at the ventral surface of penis. The urethroplasty was performed at the second stage half a year later.</p><p><b>RESULTS</b>From Feb. 2004 to Mar. 2005, 17 cases were treated successfully without any complication. After one year of following up, the appearance of glan and the urethral meatus was good and the chordee was corrected completely. The appearance of penis and scrotum was also satisfactory.</p><p><b>CONCLUSIONS</b>The technique is easily performed and very suitable for penile and penoscrotal junction hypospadias with severe chordee.</p>

The long-term contrastive result of neo-urethra reconstructed with different kinds of tissue / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe the long-term apparent and structural change of the neo-urethra inner wall reconstructed with different kinds of tissue. To compare the difference between normal and reconstructed urethra for urethra reconstruction with more appropriate materials.</p><p><b>METHODS</b>The neo-urethra inner wall was observed during operation, through urography and urethroscope. The tissue section of neo-urethra inner wall was observed through light microscope and electron microscope.</p><p><b>RESULTS</b>With unchanged structure, the appearance of neo-urethra reconstructed with skin or mucosa could be close to normal urethra after a long time. Neo-urethra made of buccal mucosa possesses some of the most important basic structures for normal urethral microenvironment to form. The structure of neo-urethra made of bladder could be close to normal urethra after a long time.</p><p><b>CONCLUSIONS</b>Buccal and bladder mucosa may be a better material than skin for urethra reconstruction.</p>

Unilateral buccinator myomucosal island flap with double opposing Z-plasty for wider palatal cleft repair / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a method to repair larger cleft palate and lengthen soft palate without oral palate raw surface and scar formation, reduce the effect on maxilla and dental arch development.</p><p><b>METHODS</b>A modified double opposing Z-plasty was used to lengthen soft palate and the nasal palate was closed by using large turn-over mucoperiosteal flaps on the oral surface of the junction of the hard palate and soft palate, oral raw surface on the palate was closed by a buccal myomucosal island flap.</p><p><b>RESULTS</b>Thirty-six palates have been repaired by this procedure, all of which had satisfactory results without flap necrosis, infection, difficulties in opening mouth and facial nerve injury except two post-operative fistulas. Eight patients were followed up and all display complete velopharyngeal closure.</p><p><b>CONCLUSIONS</b>Using unilateral buccinator myomucosal island flap with double opposing Z-plasty to repair wider palatal cleft can get a satisfactory soft palate lengthening. At the same time it can avoid bone surface exposing and scar formation; it is a safe and reliable procedure.</p>

Treatment of the congenital exstrophy of bladder / 中华整形外科杂志

<p><b>OBJECTIVE</b>To sum up the methods repairing the congenital bladder exstrophy, and to evaluate the value of the abdominal fascial flap and the lower abdominal skin flap, the tensor fascia lata musculocutaneous flap treating the bladder exstrophy.</p><p><b>METHODS</b>The abdominal rectus sheath and the fascia flap of obliquus externus abdominal and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap were used to repair the abdominal wall defection, meanwhile repair the epispadias. The maximum field of the musculocutaneous flaps was 8 cm x 10 cm.</p><p><b>RESULTS</b>12 cases were cured. The bladder exstrophy and the abdominal wall defection were repaired very well. The musculus sphincter bladder neck was reconstructed. After the second operation, the cases could urinate under self-control. 2 skin flaps of 8 musculocutaneous flaps were necrosis and cured by skin grafting.</p><p><b>CONCLUSIONS</b>Using the abdominal fascial flap and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap, is feasible for repairing the bladder exstrophy and the lower abdominal wall defection. The continuous of the musculus sphincter bladder were renewed, and then the patients could urinate under self-control. When the ischemia of the musculocutaneous flaps had occurred, the tensor fascial was survived well.</p>

The establishment of hypospadias rat model and embryoteratogenic test of Atrazine / 中华整形外科杂志

<p><b>OBJECTIVE</b>To establish an easily reproducible animal model of hypospadias and to test whether Atrazine can induce hypospadias in animal experiment.</p><p><b>METHODS</b>From the 11th to 16th day after conception, 120 conceived SD rats were divided randomly into 6 groups: one coin oil group (1 ml/kg/d), two finasteride groups (10 mg/kg/d, 20 mg/kg/d), three Atrazine groups (25 mg/kg/d, 100 mg/kg/d, 200 mg/kg/d). When all pregnant rats had delivered, the new born rats were counted and the penis appearance, urethral orifice position and micturition were observed with magnifying lens and anatomy microscope.</p><p><b>RESULTS</b>Hypospadias were found in new born male rats treated prenatally with Finasteride (10 mg/kg/d, 20 mg/kg/d) and 200 mg/kg/d Atrazine groups. The incidence was 28.30%, 67.03%, 10.23% respectively. Embryotoxic effects were observed at 25 mg/kg/d Atrazine group in 2 rats and associated with no severe maternal toxicity.</p><p><b>CONCLUSIONS</b>(1) A hypospadias SD rats model can be established by Finasteride and it is easily reproducible. (2) The Atrazine was teratogenic to the SD rats, embryotoxic effects were observed at the low dose level and associated with no severe maternal toxicity.</p>

Treating later facial nerve palsy with the method of combining free graft of de-nerve short extensor muscle of toe with the technique of inducted undermined suture / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a more effective operative method for later facial nerve palsy.</p><p><b>METHODS</b>A synthetically operative method of combining free graft of short extensor of toe with the technique of undermined inducted suture was used in 432 cases of later facial nerve palsy.</p><p><b>RESULTS</b>82% of 432 cases acquired satisfactory effect that consisted of static symmetry and dynamic rough symmetry in facial expression. 12% cases only acquired static symmetry in facial expression but the dynamic symmetry were insufficient. Unsatisfactory results were occurred in 6% cases as both the static and dynamic symmetry of their facial expression were insufficient, which acquired preferable results 2 another suspending operation 8 to 12 months later. 4 cases got post operation infection; through cases happel in foot and 2 in face. All of them were cured by the treatment of drain and antibiotic in 3 weeks. 46% cases were followed up by further consultation or telephone. The longest followed up was period 12 years, while the shortest was 1 year, and the average was 28 months. 93% patients were satisfactory with the results, and 7% patients thought that their facial expression symmetry were insufficient though their facial abnormality were improved obviously.</p><p><b>CONCLUSIONS</b>The synthetically operative method of combining free graft of short extensor of toe with the technique of undermined inducted suture was an effective method for later facial nerve palsy, and most of the patients could acquired satisfactory results. This operative method is good for popularize because of its simple operation, slight tissue injury and fews complication post-operation.</p>

Buccal musculomucosal flap for reconstruction of wide vermilion and orbicularis oils muscle defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the reconstruction of wide vermilion and orbicularis oris muscle defect with satisfactory outcome of aesthetics, sensation, and function.</p><p><b>METHODS</b>The buccal musculomucosal flap based on the anterior buccal branches of the facial artery was used to reconstruct wide defect of vermilion and orbicularis oris muscle on upper or lower lip.</p><p><b>RESULTS</b>7 patients were treated. 5 cases had no postoperative complication. Partial mucosal necrosis on the tip of the flaps happened in 2 cases, but the underlying muscle survived and was re-mucosalized spontaneously. No other complication was observed. The sensation of cold, heat and touch could be detected on the first postoperative day. Electromyographic and electron microscopic studies confirmed innervation of the muscle in the flap.</p><p><b>CONCLUSIONS</b>The buccal musculomucosal flap is a reliable reconstruction option for wide defect of vermilion and orbicularis oris muscle which can' t be reconstructed with conventional method. Satisfactory aesthetic and functional results can be achieved with the buccal musculomucosal flap.</p>

The clinical application of acellular urinary bladder submucosa to reconstructive the urethral duct of hypospadias patients / 中华整形外科杂志

<p><b>OBJECTIVE</b>Attended to apply the acellular urinary bladder submucosa in the operation of the urethral duct reconstruction of penile hypospadias.</p><p><b>METHODS</b>In 2 cases, the urethral ducts were reconstructed by using the acellular urinary bladder submucosa as dorsal half of the urethra, while the preputial island flap as ventral side. In the other patient, the urethral plate was incised, similar to Snodgrass operation, the matrix was fixed to the corpora cavernosa beneath.</p><p><b>RESULTS</b>Uroflowmetry and the urethroscopy were been performed in the one year follow up. A bell-shaped flow curve was obtained in the patient after urethroplasty using matrix graft combined with a local flap, and no fistula, stricture was found after a year or half a year follow-up.</p><p><b>CONCLUSIONS</b>The freeze-dried acellular urinary bladder submucosa had three-dimensional network structure, and the acellular urinary bladder submucosa graft combined with preputial flap for hypospadias repair provided satisfactory functional results.</p>

An experimental study on the culture of human oral mucosa epithelium using autologous serum / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the biological properties of cultured human oral mucosa epithelium using autologous serum in order to provide a new material for tissue engineering urethra.</p><p><b>METHODS</b>The cultured oral mucosa epithelium was respectively transplanted beneath the skin, above the deep fascia and in the wound of the athymic mice. The specimens were taken at 2, 3, 4, and 6 weeks posttransplantation, and processed for (1) immunofluorescence anti-HLA staining to determine graft acceptance, and (2) anti-human IV collagen and antihuman laminin immunohistochemical staining procedures to indicate the basement membrane formation.</p><p><b>RESULTS</b>All the grafts survived and grew very well. The grafts were positive to anti-HLA. Collagen type IV and laminin were detected at the dermo-epidermal junction in all groups from day 14, and increasing in density up to day 21.</p><p><b>CONCLUSIONS</b>he cultured human oral mucosa epithelium by autologous serum could develop an excellent functional epithelium tissue, which would be used to reconstruct urethra and repair wound.</p>

Mutation analysis of SRD5A2 gene in patients with hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore possible molecular mechanism of hypospadias and relationship of the mutation of SRD5A2 gene to hypospadias.</p><p><b>METHODS</b>96 blood samples from the patients with hypospadias were obtained and DNA was extracted from blood leukocytes. Polymerase chain reaction and direct sequencing were performed to analyze the coding regions of SRD5A2 gene.</p><p><b>RESULTS</b>8 mutations were detected from 14 cases, including 5 missense mutations, 1 synonymous mutation, 1 nonsense mutation and 1 frameshift mutation. The mutations are in 1st, 4th and 5th exon. Gln6stop, His232His, Phe234Leu and frameshift mutations are novel.</p><p><b>CONCLUSIONS</b>Exon 4 is a hot spot region of mutation within SRD5A2 gene, and about 10 percent of hypospadiac patients complicated with SRD5A2 dysfunction or deficiency.</p>

Twice delaying of the expanded flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce a new method for enlarging the survival area of an expanded flap.</p><p><b>METHODS</b>After the skin expander was inflated with enough injection, the first delaying was performed. In the operation, two incisions were made in the skin and subcutaneous tissue superficial to the expander capsule on both sides of the long axis of the expanded flap. After 10 to 14 days, the second delaying followed, in which one pedicle was divided to form a unilateral-pedicled, super-long random flap. When the flap was transferred to the recipient Since 2000,this technique has been used in 16 patients. All the area, the door site was closed directly.</p><p><b>RESULTS</b>flaps survived completely.</p><p><b>CONCLUSIONS</b>The technique of twice delaying can enlarge the survival area of the expanded skin flap.</p>

Bacteriology study of hypospadias / 中华整形外科杂志

<p><b>OBJECTIVE</b>This clinical study was to explore why the neo-urethra is liable to be infected after hypospadias operation, find the source and the common floras of infection, and accordingly, improve the peroperation procedures so as to reduce postoperative infection rate.</p><p><b>METHODS</b>The pathogenic floras were examined and analyzed by germiculture and karyotype analysis.</p><p><b>RESULTS</b>The bacteria in the neo-urethra mostly came from the orifice and the reconstruction material of the urethra. The most common floras that caused infection were gram-positive coccus. The most sensitive antibiotics for hypospadias infection were demethylvancomycin.</p><p><b>CONCLUSION</b>The postoperative infection of hypospadias is incisional, not the urinary system infection. Because the microenvironment of the neo-urethra is more suitable for infection than that of the skin or mucosa, the reconstructed urethra is likely to be infected.</p>

Rabbit urethral defect repair with freeze-dried acellular bladder submucosa / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the result of urethral defect repair using freeze-dried acellular bladder submucosa.</p><p><b>METHODS</b>The freeze-dried acellular bladder submucosa was obtained from human cadaveric bladder submucosa using freeze-thawed enzymatic treatment and the freeze-drying technique. 18 male New Zealand rabbits were used in this experiment. A defect of 1.0 cm x 0.5 cm was created in the ventral urethra of the animal. The acellular matrix was grafted to the urethral defect in 14 rabbits. The other 4 animals underwent a sham operation as the controls. From postoperative one to twenty-four weeks, the animals underwent retrograde urethrography at certain intervals. The grafts of the acellular matrix were taken and prepared for histological evaluation.</p><p><b>RESULTS</b>No obvious urethral stricture was observed in the 14 matrix-grafted animals. Histological examinations of the specimens showed progressive infiltration of cells and vascular vessels. Complete epithelization was obtained at 2 weeks. The orientation of collagen fibers in the matrix-grafted area tended to be regular with time.</p><p><b>CONCLUSIONS</b>Freeze-dried acellular bladder submucosa may be a suitable material for urethral defect repair, which induces urethral mucous cells to migrate, grow and epithelialize.</p>