An experiment study and clinical observation of the influence of free-skin-grafted scrotal avulsion injuries on spermatogenesis / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the influence of Free-skin-grafted penoscrotal avulsion injuries on spermatogenesis.</p><p><b>METHODS</b>Forty-two male New Zealand albino rabbits during child-bearing period were divided into the experimental group (n = 24) and the control group (n = 18) using random digits table, and 24 female rabbits with reproductive history were used for mating experiment. The experimental group animal's scrotum skin were excised, and the split skin from abdominal region was used to repair the skin defect of scrotum. The control group did not any processing. Six rabbits were randomly chosen respectively in control group and on the 3rd and 8th weekend after the model was successfully established in experimental group. The testicular surface temperature was measured in the eighteen rabbits using the method of burying thermometer, then the testicular biopsy were performed for hematoxylin-eosin (HE) staining. On the 8(th) weekend after the model was successfully established in experimental group, matched-pair feed was performed in the other 12 rabbits respectively in experimental group and in control group. Observation of corresponding mother rabbit fertility. Three patients of penoscrotal avulsion injuries were treated using split skin grafts, and the information of sex life and the quality of sperm were obtained by follow up.</p><p><b>RESULTS</b>The testicular surface temperature was similar on the 3rd and 8th weekend after the model was successfully established in experimental group [(36.15 ± 0.24)°C, (36.77 ± 0.42)°C] with that of the control group. Testis tissue (HE) staining showed the tier of spermatogenic cells was rule arrangement and lot of mature sperms were found in the convoluted seminiferous tubules in control group. The tier of spermatogenic cells was diminished and disposed derangement, the spermatozoa were not seen on the 3(th) weekend of the experiment group. The tier of spermatogenic cells was increased and some spermatozoa were seen on the 8th weekend of the experiment group. Male and female matched-pair feed showed the experimental group conception rate 8/12, and 4.1 ± 3.2 rabbit babies were born averagely, while that of was 12/12 and 6.0 ± 1.3 in control group (P > 0.05). The skin grafts there were some contracture in early stage (1 - 2 months) when the skin grafts applied to repair the avulsing scrotum in three patients. But the skin grafts became loose with downward sagging and there were the good cosmetic result in one year, and without any contracture. The sperm quality was normal after the skin grafts applied to repair the avulsing scrotum in the late stage.</p><p><b>CONCLUSIONS</b>The skin grafting is little arrest the testicle spermatogenesis in the three methods (skin flap reconstruction scrotum, testicle buried, split skin grafting) that have usually been used to repair scrotum skin lose. For a young male, the best treatment for penoscrotal avulsion injuries is free skin grafting, while skin flaps are not recommended for reconstructing the scrotum.</p>

Repair of wounds in popliteal fossa scar with perforator flaps of gastrocnemius medial head / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the effect of perforator flaps of medial head of gastrocnemius muscle on repairing popliteal fossa scar wounds.</p><p><b>METHODS</b>Ten patients with scar in popliteal fossa hospitalized from January 2005 to January 2010 were repaired with perforator flaps of medial head of gastrocnemius muscle. The scar was resulted from burn in 8 patients, and from operation in 2. The duration of the scar was 3 months to 11 years, and area of the scar ranging from 6 cm × 3 cm to 10 cm × 6 cm. Ultrasonic Doppler was used to detect the musculocutaneous perforator vessel of the medial sural artery at the position 10 to 17 cm from the fold of the popliteal fossa and 2 to 5 cm from the posterior midline before surgery. Then flap transplantation surgery was performed. Donor site wounds with width less than 5 cm were sutured directly, and those wider than 5 cm were repaired with skin transplantation.</p><p><b>RESULTS</b>All the flaps survived. Flap size ranged from 7 cm × 5 cm to 12 cm × 7 cm. All patients were followed up for 3 to 30 months, and the flaps were found to have a good appearance. Patients could walk with heavy load without lameness. The function of knee joint of the affected limb was the same as that of the opposite limb. No obvious depression was observed in donor sites.</p><p><b>CONCLUSIONS</b>The perforator flaps of medial head of gastrocnemius muscle can be used to repair the popliteal fossa scar wound with satisfactory result.</p>

Repairing small wounds around ankle by medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle.</p><p><b>METHODS</b>From Jan. 2005 to Jun. 2009, 10 cases with small wounds around ankle were treated with medial planta island flaps pedicled with anterior tibial artery perforator. The flap size ranged from 7.5 cm x 2.8 cm to 13.0 cm x 5.0 cm. The wounds at the donor sites were covered with skin grafts.</p><p><b>RESULTS</b>All the 10 flaps and skin grafts were survived with primary healing. The patients were followed up for 6-12 months with satisfactory cosmetic results. The 2-point discrimination was 4-6 mm when the proximal end of saphenous nerve was not injured, and it was 9-10 mm when the nerve was injured or cut off. The patients could walk with no occurrence of ulcer in flaps or donor site.</p><p><b>CONCLUSIONS</b>The medial planta island flaps pedicled with anterior tibial artery perforator can effectively repair the small wounds around ankle with reliable blood supply.</p>

The expression of Cyclin A and p21cip1 in fibroblast of hypertrophic scar / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the relation of the mRNA and protein expression of Cyclin A and p21cip1 in different stages hypertrophic scar fibroblast (FB) with its cell cycle, so as to provide theoretical evidence for intervention therapy of cell cycle gene being used in hypertrophic scar.</p><p><b>METHODS</b>The hypertrophic scar samples at different stages (the third month, the sixth month, the twelfth month, the twenty-fourth month) in 32 cases and the normal skin samples in 8 cases were used in this study. The expression of Cyclin A, p21cip1 mRNA and protein was detected by quantitative real-time PCR and Western Blot. And at the same time, the flow cytometer was used to detect the fibroblastic cell life cycle.</p><p><b>RESULTS</b>1) The expression of Cyclin A mRNA and protein in the third month group, the sixth month group, the twelfth month group, the twenty-fourth month group were 19.34 +/- 2.41, 0.99 +/- 0.11; 19.30 +/- 1.42, 0.96 +/- 0.09; 10.73 +/- 2.93, 0.66 +/- 0.58; 9.29 +/- 0.97, 0.65 +/- 0.14, respectively. And in corresponding stages, the expression of p21cip1 mRNA and protein were 2.80 +/- 0.69, 0.35 +/- 0.07; 4.95 +/- 1.82, 0.44 +/- 0.07; 9.98 +/- 1.19, 0.56 +/- 0.06; 10.25 +/- 1.46, 0.59 +/- 0.06, respectively. The expression intensity of Cyclin A mRNA and protein was no significantly different between the third month group and the sixth month group (P > 0. 05), but it was higher respectively than that in the twelfth month group, the twenty-fourth month group and normal group (P < 0.05). And the expression intensity was no different between the above three groups (P > 0.05). The expression intensity of P21cip1 mRNA and protein in the third month group was lower than that in the sixth month group, but that in the above two groups was lower respectively than that in the twelfth month group, the twenty-fourth month group and normal group (P < 0.05). And the expression intensity had no difference between the three later stage groups (P > 0.05). 2) Most FB were in S and G2/M stage (cycle) in 3rd month, 6th month group. And most FB were in G0/G1 stage (cycle) in 12th month, 24th month group and normal group.</p><p><b>CONCLUSIONS</b>The expression of mRNA and protein of Cyclin A in hypertrophic scar changes from high level to low level as the hypertrophic scar develops, while the expression of P21cip1 changes from low level to high level. The mRNA and protein expression of Cyclin A and p21cip1 respectively are basically corresponded to different stages of hypertrophic scar. The distribution of cell life cycle of fibroblastic are also corresponded to the expression intensity of Cyclin A and p21cip1 in different stages hypertrophic scar. An early stage intervention to the two gene can be effective to prevent from the genesis and development of hypertrophic scar.</p>