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Objective:To study the effect of different sufentanil doses on hemodynamics and interleukin (IL)-6 in children with ventricular septal defect repair (VSDR).Methods:A total of 96 children who underwent VSDR surgery in Three Gorges Hospital Affiliated to Chongqing University from January 2016 to June 2019 were selected. Children with VSDR were enrolled and divided into A group (0.8 μg/kg), B group (1.0 μg/kg) and C group (1.1 μg/kg) according their sufentanil doses. The heart rate (HR), contraction pressure (SBP), the brain electric double frequency index (BIS) and IL-6 in different time were studied and compared. The adverse cardiovascular events and other indicators were studied and compared.Results:At t 2 to t 6, there were significant difference among the three groups in HR, A group: (104.62 ± 10.58), (128.73 ± 13.29), (127.59 ± 13.53), (125.62 ± 12.60) and (118.49 ± 11.62) times/min, B group: (100.27 ± 10.11), (119.33 ± 12.62), (116.57 ± 11.40), (113.57 ± 11.94) and (113.37 ± 11.46) times/min, C group: (87.92 ± 8.87), (98.62 ± 9.69), (94.42 ± 9.38), (88.72 ± 8.62) and (89.36 ± 9.17) times/min; SBP, A group: (79.54 ± 7.59), (102.75 ± 10.62), (90.62 ± 9.52), (85.19 ± 8.62) and (83.98 ± 8.62) mmHg (1 mmHg = 0.133 kPa), B group: (76.74 ± 7.28), (90.45 ± 9.57), (87.38 ± 8.51), (84.72 ± 8.50) and (83.77 ± 8.58) mmHg, C group: (70.62 ± 7.27), (75.62 ± 7.83), (72.69 ± 7.80), (71.28 ± 7.43) and (71.39 ±7.16) mmHg, P<0.05. At t 2 to t 4, there were significant differences among the three groups in BIS, A group: 48.64 ± 5.03, 53.58 ± 5.71 and 59.61 ± 5.87, B group: 48.79 ± 5.12, 50.23 ± 5.24 and 57.75 ± 5.66, C group: 43.59 ± 4.62, 50.31 ± 5.34, 55.26 ± 5.53, P<0.05. At T 2 to T 6, there was a significant difference among the three groups in IL-6, A group: (0.41 ± 0.06), (0.49 ± 0.11), (0.53 ± 0.13), (0.82 ± 0.17) and (0.61 ± 0.15) μg/L, B group: (0.38 ± 0.05), (0.42 ± 0.08), (0.46 ± 0.09), (0.75 ± 0.14) and (0.53 ± 0.12) μg/L, C group: (0.35 ± 0.05), (0.40 ± 0.06), (0.43 ± 0.07), (0.72 ± 0.12) and (0.51 ± 0.11) μg/L, P<0.05. Compared with that in A group and C group, HR, SBP and BIS in B group had relatively low volatility. At T 2 to T 6, IL-6 level in A group was significantly higher than that in B group and C group, and there was a statistically significant difference ( P<0.05). The incidence of cardiovascular adverse events in A group and C group was significantly higher than that in B group, and there was statistical difference ( P<0.05). Conclusions:1.0 μg/kg sufentanil can have less effect on hemodynamics and IL-6 in children with VSDR with less adverse cardiovascular events and other indicators.
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BACKGROUND: Periosteum, as the storage site and recruitment scaffold of progenitor cells and growth factors, plays an important role in the blood supply of bone tissue and the formation and regeneration of bone. Thus, it has become a research hotspot in recent years to develop an artificial periosteum material which can simulate natural periosteum both in structure and function. OBJECTIVE: To review the research progress of artificial periosteum material and its application in clinical treatment. METHODS: The relevant documents published by PubMed database up to February 2020 were searched by computer with the search term of “periodium, tissue engineering, artificial, regeneration, repair”. RESULTS AND CONCLUSION: The artificial periosteum simulates the structure and function of natural periosteum through three elements: scaffolds, cells and factors, which provide a new possibility for the clinical treatment of periosteal tissue repair and bone regeneration. At present, the artificial periosteum can be divided into cell-sheet periosteum material, acellular-scaffold periosteum material and artificially synthetic scaffold periosteum material. Cell-sheet artificial periosteum is relatively simple to prepare and is a kind of tissue engineering periosteum material which has been put into clinical use earlier. Acellular-scaffold artificial periosteum can keep its natural structure or element to the greatest extent. The material of artificially synthetic scaffold is rich and convenient, and has a low incidence of anti-rejection. These materials all showed good osteogenic effect. However, at present, the bionic research on the structure and function of artificial periosteum is still in its infancy, and further improvement is still needed in material selection, theoretical design and other aspects, so as to make it more mature in biological bionic function.
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@#Objective To observe the short-term therapeutic outcomes of atrial septal defects (ASD) repair using on-pump beating-heart technique assisted by robotic surgery system (Da Vinci Si) or thoracoscopy. Methods Clinical data of 50 patients undergoing ASD repair at the First Affiliated Hospital of Anhui Medical University from January 2015 to December 2018 were retrospectively analyzed. According to the different surgical methods, patients were divided into a robot group and a total thoracoscopy group. In the robot group, there were 35 patients including 11 males and 24 females, at an average age of 42.1±16.8 years, and in the total thoracoscopy group there were 15 patients including 8 males and 7 females at an average age of 38.4±10.9 years. During follow-up, the left ventricular ejection fraction, left and right atrial diameter, and right ventricular end-diastolic diameter in the cardiac Doppler echocardiography were recorded. The operation time, extracorporeal circulation time, ventilation time, postoperative ICU stay, postoperative hospital stay, perioperative pleural drainage and early complications were compared between the two groups. Results In the perioperative period, the robot group had less operation time (3.8±0.3 h vs. 6.1±1.4 h), extracorporeal circulation time (72.3 ± 10.4 min vs. 139.1 ± 32.8 min), ventilation time (5.5±1.2 h vs. 9.5 ± 2.1 h), postoperative hospital stay (6.7±0.5 d vs. 9.8 ± 0.6 d) and thoracic drainage (253.4±26.8 mL vs. 289.3 ± 29.5 mL) than the total thoracoscopy group (P<0.05), while the postoperative complications were not statistically significant between the two groups (P>0.05). All patients were reviewed by color Doppler ultrasound at 1 month after operation. The postoperative dilated right atrium, right ventricle and left atrium were smaller than those before surgery. Conclusion For patients undergoing ASD repair, robot-assisted and total thoracoscopy can achieve good results, but the robot group has more advantages in terms of operation time, extracorporeal circulation time, ventilation time, postoperative hospital stay and thoracic drainage.
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BACKGROUND: Although desired cartilage repair has been realized via tissue engineering technology, these achievements mainly focus on small-size defect under a normal physical condition. However, cartilage defects are always accompanied by the underlying diseases in clinical practice, such as osteoarthritis and rheumatoid arthritis. Meanwhile, the location, scope, and depth of cartilage defects are uncertain, which brings a great challenge in cartilage tissue repair. OBJECTIVE: To summarize the methods of repairing articular cartilage defects at different locations and under inflammatory condition. METHODS: We searched PubMed and CNKI with the search terms “cartilage defect regeneration, osteochondral, growth plate, weight-bearing area, inflammatory” in Chiense and English to retrieve related papers published before March 2019. A total of 209 papers were retrieved and 86 were included in the final analysis according to inclusion and exclusion criteria. RESULTS AND CONCLUSION: For articular cartilage defects under different special conditions, the repair goals and strategies are different. For repair of full-layer cartilage defects and osteochondral structure defects, multi-layered scaffolds are often used to repair the unique stratified cartilage structure and subchondral bone structure, while avoiding the problem of heterotopic ossification in neonatal cartilage. To avoid deformity after long bone maturation, growth factors such as insulin-like growth factor and bone morphogenetic protein 7 should be added to continuously stimulate the repair of the growth plate and promote bone growth. For cartilage repair in the weight-bearing area, the scaffolds should have good mechanical property, which ensure not to undergo severe deformation and structural damage when loaded. In addition, the new cartilage tissue has sufficient mechanical strength to support sustained longitudinal pressure and wear. For cartilage defects in the inflammatory state, both inflammation management and cartilage defect repair should be considered, and introduction of mesenchymal stem cells can regulate immune function and promote tissue regeneration, such that articular cartilage defect can be completely repaired.
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BACKGROUND: Polyetheretherketone (PEEK) and Its composites have a unique set of properties, and 3D printing technology can customize personalized Implants according to the patient's condition, and the effective combination of the two plays a significant role In the field of bone repair. OBJECTIVE: To summarize the application status of PEEK and Its composite combined with 3D printing technology In the field of bone repair, and to further predict the application prospects of the effective combination of the two. METHODS: CNKI, PubMed, and Web of Science databases were retrieved with the search terms “PEEK, PEEK composites, bone defect repair, PEEK Implants, PEEK 3D printing, prosthodontlcs” in English and Chinese, respectively, for the articles published from April 1995 to April 2019. Totally 147 articles were searched, and finally 51 eligible articles were enrolled for review in accordance with the inclusion and exclusion criteria. RESULTS AND CONCLUSION: Biologically active materials and the particles or fibers with Improved mechanical properties were Introduced Into the PEEK matrix to prepare its composite. 3D printing technology was used to precisely customize Implants that are highly matched to the patient's defect. The Implants with good biocompatibility, bioactlvity, and mechanical properties exhibited good therapeutic effects In the repair of skull, jaw, spine, lumbar vertebra, artificial joint and oral defects. They Improved patient satisfaction after treatment. This article summarized the application of PEEK, its composite and 3D printing technology In the repair of various bone defects, and expressed its views on the application and prospect of personalized PEEK implants or prostheses prepared with 3D printing technology.
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Objective@#To explore the flap design and clinical applications of the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery in defect reconstruction.@*Methods@#Between September 2009 and December 2018, 27 patients with soft tissue defects from lower extremities were involved in this study, including 15 males and 12 females, with an average age of 34.6 years old (range, 3 to 73 years old). Before surgery, the type of the flap to be used was designed preliminarily by evaluating the location, size and shape of the lesion or defect. The perforators of the lateral circumflex femoral artery were explored using an ultrasound Doppler probe, marked on skin. The computed tomographic angiography was also used to get more information of the branches of the lateral circumflex femoral artery when possible. The propeller flaps were divided into typeⅠ, Ⅱ, Ⅲ, and Ⅳ according to the perforators that originated from the transverse, descending, oblique, and rectus femoris branches of the lateral circumflex femoral artery, respectively. The type Ⅱ flap was subdivided into type Ⅱa and type Ⅱb flaps that were based on antegrade and reverse flow from the descending branch. The defects were reconstructed using the perforator propeller flap.@*Results@#Twenty-seven patients underwent reconstruction of defects using the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery including 3 type Ⅰ flap, 12 type Ⅱa, 2 type Ⅱb, 10 type Ⅲ and 3 type Ⅳ. The size, pedicle length and rotation angle of the flaps were 12 cm×6 cm to 30 cm×15 cm, 4 cm to 15 cm, and 60 to 180 degrees, respectively. Total necrosis occurred in one flap and small-sized distal necrosis in another one. Minor complications occurred in two flaps and the remaining propeller flaps survived completely. All patients were followed up from one to 25 months and mean follow-up time was 9.9 months. Tumor recurrence was noticed in one patient. All patients were satisfied with the final functional and aesthetic outcomes.@*Conclusions@#For appropriate cases, reconstruction of defects from the groin to the knee could be achieved by using the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery, with advantages of easy-to-operate and minor donor-site morbidity.
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Objective@#To compare the pedicled supraclavicular artery island flap (SCAIF) and the pectoralis major myocutaneous flap (PMMF) for oral reconstruction after cancer resection.@*Methods@#This is a retrospective study from May 2007 to May 2017. Sixty-one patients from the Jiangxi University of Traditional Chinese Medicine and the First Affiliated Hospital of Nanchang University, were included. All the patients underwent oral squamous cell carcinoma resection and pedicled flap reconstruction. Sixteen patients were performed SCAIFs (group A), and 45 were performed PMMFs (group B). The flap survival rate, flap size, flap preparation time, the presence of scar hyperplasia, pigmentation and dysfunction (temporary or permanent) were compared between these two groups.@*Results@#The survival rate of flaps in group A was 93.75% (15/16), and the survival rate of flaps in group B was 95.56% (43/45). There was no statistically significant difference in the survival rate of flaps, the average skin flap size or flap produce time between these 2 groups. There were no scar hyperplasia, pigmentation and dysfunction was observed in group A. However, scar hyperplasia (n=11), pigmentation (n=10) and dysfunction (n=12) occurred in group B. The difference was statistically significant (P<0.05).@*Conclusions@#This study suggests that SCAIF is more reliable, and brings more satisfied outcome, when compared with the PMMF.
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Objective@#To research the clinical effect of platelet rich plasma combined with Bio-oss artificial bone meal in repairing bone defects around implants.@*Methods@#From January 2015 to January 2017, 70 cases who completed the implant repair in Lishui People's Hospital, and later confirmed the defects around the implant were selected in the research.They were equally divided into observation group and control group according to admission, with 35 cases in each group.The control group was treated with Bio-oss artificial bone powder.The observation group was treated with platelet rich plasma combined with Bio-oss artificial bone powder.The clinical effects of the two groups were compared and analyzed.@*Results@#Before treatment, the probe depth (PD), clinical attachment loss (CAL), plaque index (PI), gingival sulcus hemorrhage index (SBI) of the observation group and the control group were (7.18±1.31)mm, (5.68±0.87)mm, (1.23±0.31), (2.48±0.34) and (7.22±1.28)mm, (5.74±0.83)mm, (1.27±0.33), (2.53±0.36), respectively, which were significantly higher than those after treatment (all P<0.05). Before treatment, the bone mineral density (BMD) levels of the two groups were (35.48±4.58)g/cm3 and (35.74±4.61)g/cm3, respectively, which were significantly lower than those after treatment (all P<0.05). The levels of PD, CAL, PI and SBI in the observation group at 3 months and 6 months after treatment were (4.48±1.01)mm, (4.27±0.53)mm, (0.68±0.21), (1.12±0.13) and (3.43±0.76)mm, (3.58±0.54)mm, (0.38±0.07), (0.41±0.08), respectively, which were significantly lower than those in the control group [(5.19±0.83)mm, (4.83±0.71)mm, (0.89±0.27), (1.46±0.21) and (4.14±0.98)mm, (4.21±0.62)mm, (0.49±0.11), (0.63±0.13)], the differences were statistically significant (t=3.213, 3.739, 3.632, 8.144 and 3.387, 4.533, 4.991, 8.526, P=0.002, 0.000, 0.000, 0.000, 0.001, 0.000, 0.000, 0.000, 0.000, 0.000). The levels of TA anterior temporalis muscle EMG and MA masseter muscle EMG in the two groups at 6 months after treatment were (76.81±15.17)mV, (67.56±14.43)mV, (74.24±13.28)mV, (68.27±13.03)mV, (66.44±13.28)mV, (58.76±13.07)mV, (65.58±11.55)mV, (59.04±10.76)mV, respectively, which were significantly higher than those before treatment [(46.48±11.15) mV, (38.19±13.04) mV, (54.83±12.57) mV, (56.48±13.13) mV and (45.71±10.98) mV, (38.23±13.11)mV, (55.14±12.69) mV, (56.61±13.08) mV] (all P<0.05). After treatment, the ICP-HB, ICMAP-MC, TA, EMG levels in the observation group were significantly higher than those in the control group, the differences were statistically significant (t=3.042, 2.674, 2.911, 2.994, P=0.003, 0.009, 0.004 and 0.003).@*Conclusion@#The effect of rich plate plasma combined with Bio-oss artificial bone powder on the repair of bone defect around the implant is significant.The platelet rich plasma can speed up and improve the repair speed and repair quality of bone defect around the implant, so that the therapeutic effect of implant repair can be maintained for a long time.
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Objective To research the clinical effect of platelet rich plasma combined with Bio-oss artificial bone meal in repairing bone defects around implants.Methods From January 2015 to January 2017,70 cases who completed the implant repair in Lishui People's Hospital,and later confirmed the defects around the implant were selected in the research.They were equally divided into observation group and control group according to admission,with 35 cases in each group.The control group was treated with Bio-oss artificial bone powder.The observation group was treated with platelet rich plasma combined with Bio-oss artificial bone powder.The clinical effects of the two groups were compared and analyzed.Results Before treatment,the probe depth (PD),clinical attachment loss (CAL),plaque index (PI),gingival sulcus hemorrhage index (SBI) of the observation group and the control group were (7.18 ± 1.31)mm,(5.68 ±0.87)mm,(1.23 ±0.31),(2.48 ±0.34) and (7.22 ± 1.28)mm,(5.74 ±0.83) mm,(1.27 ± 0.33),(2.53 ± 0.36),respectively,which were significantly higher than those after treatment (all P ＜ 0.05).Before treatment,the bone mineral density (BMD) levels of the two groups were (35.48 ± 4.58) g/cm3 and (35.74 ±4.61) g/cm3,respectively,which were significantly lower than those after treatment (all P ＜ 0.05).The levels of PD,CAL,PI and SBI in the observation group at 3 months and 6 months after treatment were (4.48 ± 1.01) mm,(4.27 ±0.53)mm,(0.68 ±0.21),(1.12 ±0.13) and (3.43 ±0.76) mm,(3.58 ±0.54)mm,(0.38 ±0.07),(0.41 ±0.08),respectively,which were significantly lower than those in the control group [(5.19 ± 0.83) mm,(4.83 ±0.71)mm,(0.89 ±0.27),(1.46 ±0.21) and (4.14 ±0.98)mm,(4.21 ±0.62)mm,(0.49 ±0.11),(0.63 ±0.13)],the differences were statistically significant (t =3.213,3.739,3.632,8.144 and 3.387,4.533,4.991,8.526,P =0.002,0.000,0.000,0.000,0.001,0.000,0.000,0.000,0.000,0.000).The levels of TA anterior temporalis muscle EMG and MA masseter muscle EMG in the two groups at 6 months after treatment were (76.81 ± 15.17) mV,(67.56 ±14.43)mV,(74.24 ± 13.28) mV,(68.27 ± 13.03) mV,(66.44 ± 13.28) mV,(58.76 ± 13.07) mV,(65.58 ±11.55) mV,(59.04 ± 10.76) mV,respectively,which were significantly higher than those before treatment [(46.48 ±11.15) mV,(38.19± 13.04) mV,(54.83 ±12.57) mV,(56.48 ±13.13) mV and (45.71 ±10.98) mV,(38.23 ±13.11)mV,(55.14±12.69) mV,(56.61 ± 13.08) mV] (all P ＜0.05).After treatment,the ICP-HB,ICMAP-MC,TA,EMG levels in the observation group were significantly higher than those in the control group,the differences were statistically significant (t =3.042,2.674,2.911,2.994,P =0.003,0.009,0.004 and 0.003).Conclusion The effect of rich plate plasma combined with Bio-oss artificial bone powder on the repair of bone defect around the implant is significant.The platelet rich plasma can speed up and improve the repair speed and repair quality of bone defect around the implant,so that the therapeutic effect of implant repair can be maintained for a long time.
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Osteoarthritis is a chronic progressive disease characterized by cartilage degenerative diseases. Due to the lack of vascular supply of articular cartilage and poor regeneration of chondrocytes, it is difficult to repair the cartilage with degenerative wear. A large number of studies have confirmed that bone marrow mesenchymal stem cells, adipose-derived mesenchymal stem cells, umbilical cord blood mesenchymal stem cells, umbilical cord mesenchymal stem cells, synovial mesenchymal stem cells, osteoarthritis joint fluid-derived mesenchymal stem cells, etc. can be effective to relieve osteoarthritis and repair damaged cartilage. Mesenchymal stem cells can directly differentiate into chondrocytes under appropriate microenvironment, and they also have immunosuppressive, anti-inflammatory and paracrine effects. In this paper, the research progress of basic experiments and clinical application of mesenchymal stem cells from different sources in osteoarthritis is reviewed to better promote the research progress of stem cell therapy for osteoarthritis.
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In maxillofacial surgery, there is a significant need for the design and fabrication of porous scaffolds with customizable bionic structures and mechanical properties suitable for bone tissue engineering. In this paper, we characterize the porous Ti6Al4V implant, which is one of the most promising and attractive biomedical applications due to the similarity of its modulus to human bones. We describe the mechanical properties of this implant, which we suggest is capable of providing important biological functions for bone tissue regeneration. We characterize a novel bionic design and fabrication process for porous implants. A design concept of "reducing dimensions and designing layer by layer" was used to construct layered slice and rod-connected mesh structure (LSRCMS) implants. Porous LSRCMS implants with different parameters and porosities were fabricated by selective laser melting (SLM). Printed samples were evaluated by microstructure characterization, specific mechanical properties were analyzed by mechanical tests, and finite element analysis was used to digitally calculate the stress characteristics of the LSRCMS under loading forces. Our results show that the samples fabricated by SLM had good structure printing quality with reasonable pore sizes. The porosity, pore size, and strut thickness of manufactured samples ranged from (60.95± 0.27)% to (81.23±0.32)%, (480±28) to (685±31) μm, and (263±28) to (265±28) μm, respectively. The compression results show that the Young's modulus and the yield strength ranged from (2.23±0.03) to (6.36±0.06) GPa and (21.36±0.42) to (122.85±3.85) MPa, respectively. We also show that the Young's modulus and yield strength of the LSRCMS samples can be predicted by the Gibson-Ashby model. Further, we prove the structural stability of our novel design by finite element analysis. Our results illustrate that our novel SLM-fabricated porous Ti6Al4V scaffolds based on an LSRCMS are a promising material for bone implants, and are potentially applicable to the field of bone defect repair.
Subject(s)
Humans , Alloys , Bionics , Bone Substitutes/chemistry , Bone and Bones/pathology , Compressive Strength , Elastic Modulus , Finite Element Analysis , Lasers , Materials Testing , Maxillofacial Prosthesis Implantation , Porosity , Pressure , Printing, Three-Dimensional , Prostheses and Implants , Prosthesis Design , Stress, Mechanical , Surgery, Oral/instrumentation , Tissue Engineering/methods , Titanium/chemistryABSTRACT
In maxillofacial surgery, there is a significant need for the design and fabrication of porous scaffolds with customizable bionic structures and mechanical properties suitable for bone tissue engineering. In this paper, we characterize the porous Ti6Al4V implant, which is one of the most promising and attractive biomedical applications due to the similarity of its modulus to human bones. We describe the mechanical properties of this implant, which we suggest is capable of providing important biological functions for bone tissue regeneration. We characterize a novel bionic design and fabrication process for porous implants. A design concept of “reducing dimensions and designing layer by layer” was used to construct layered slice and rod-connected mesh structure (LSRCMS) implants. Porous LSRCMS implants with different parameters and porosities were fabricated by selective laser melting (SLM). Printed samples were evaluated by microstructure characterization, specific mechanical properties were analyzed by mechanical tests, and finite element analysis was used to digitally calculate the stress characteristics of the LSRCMS under loading forces. Our results show that the samples fabricated by SLM had good structure printing quality with reasonable pore sizes. The porosity, pore size, and strut thickness of manufactured samples ranged from (60.95± 0.27)% to (81.23±0.32)%, (480±28) to (685±31) µm, and (263±28) to (265±28) µm, respectively. The compression results show that the Young’s modulus and the yield strength ranged from (2.23±0.03) to (6.36±0.06) GPa and (21.36±0.42) to (122.85±3.85) MPa, respectively. We also show that the Young’s modulus and yield strength of the LSRCMS samples can be predicted by the Gibson-Ashby model. Further, we prove the structural stability of our novel design by finite element analysis. Our results illustrate that our novel SLM-fabricated porous Ti6Al4V scaffolds based on an LSRCMS are a promising material for bone implants, and are potentially applicable to the field of bone defect repair.
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Objective@# To observe the clinical effect of the modified M-shaped flap for repairing defects following resection of lower lip cancer and to provide a reference for clinical application.@*Methods @#Fourteen cases using modified M-shaped flaps to repair lower lip cancer surgery defects were retrospectively analyzed. The postoperative follow-up patients’ flap survival, mouth opening, denture use, bilateral mouth angle symmetry, recurrence and survival were analyzed.@*Results @#Fourteen patients with lower lip cancer underwent reconstruction immediately after surgery, and the defect range after tumor resection was 30% to 50% of the lower lip. The continuity of the orbicularis oculi muscle is reconstructed by modified M-shaped flap to transfer bilateral residual lip tissue. The blood supply to the flap is stable. All patients’ flaps survived completely without complications, such as hemorrhage, infection or flap necrosis, and their lip movement and sensation recovered well. There were no obvious obstacles in opening and closing or pronunciation and dietary function, and the mean maximum opening was (3.06 ± 0.23) cm. Three patients used active dentures, which could be removed normally. All patients’mouths were preserved. Approximately 85.7% of patients (12/14) had bilateral symmetry of the bilateral mouth, the flaps matched the facial color, and the lower lip was naturally beautiful, as the scar was not obvious. After 6 months to 4 years of follow-up (mean 2 years and 6 months), no recurrence or death occurred.@*Conclusion @#The modified M-shaped valve design is simple and easy to operate. This method can be applied to 30% to 50% defect reconstructions of the lower lip to retain the corner of the mouth.
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Objective To explore the clinical effects of modified pedicled pectoralis major myocutaneous flaps(PMMFs) in repairing postoperative defects following head and neck malignant tumor radical operation.Methods Twenty-eight patients with surgical defects after head and neck malignant tumor operation in this hospital from September 2013 to January 2017 were selected and performed the repairing reconstruction by modified PMMFs,then observed and followed up for the survival of the flaps.Results All 28 cases were followed-up for 3-36 months,all modified PMMFs survived.Using modified PMMFs to repair surgical defects following head and neck malignant tumor operation had the advantages of high survival rate and less trauma;meanwhile the swallow and language function could obtain the maximal recovery.Conclusion Using modified PMMFs to repair surgical defects following head and neck malignant tumor operation has good clinical curative effect and is worth clinical application.
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Objective To summarize the surgery skills and evaluate the clinical outcome of submental island flap for repairing oral defect after radical resection of oral cancer. Methods A total of 25 consecutive patients underwent submental island flap reconstruction after ablative surgery for oral cancer from January 2015 to May 2017 were enrolled in this study. The patterns of venous return, the technique notes and postoperative complications were summarized. The oncological safety of submental island flap in oral reconstruction was analyzed. Results The submental island flaps were harvested with the sizes ranging from(5 cm×3 cm)to(12 cm×5 cm).The mean operation time was(350.5±50.5)min.The vein of the flap was found to drain into the facial vein,and then returned to the internal jugular vein in 17 patients(68.0%), into the external jugular vein in 4 patients(16%),and into the anterior jugular vein in 4 patients(16%).Twenty-four flaps survived completely,and 1 flap failed due to the damage of the submental artery.Wound infection occurred in only 1 patient, and primary wound healing was observed in the other 24 patients. Eight patients (32.0%) with cervical lymph node metastases were verified by the postoperative pathological examination, 4 patients were submandibular lymph node metastases.The prevalence of occult lymph node metastasis involving level Ⅰwas 16.0%.The mean follow-up period was (14.3 ± 5.2) months. Local recurrence was found in 1 patient and cervical recurrence in 2 patients without postoperative radiotherapy during the follow-up. Conclusion There are three various drainage patterns for the venous return of submental island flap.Our data suggest that vein drainage of the flap into the external jugular vein and the anterior jugular vein,which are previously overlooked,should receive greater attention during the harvest of submental flap to avoid venous congestion and flap loss.Close follow-up or postoperative radiotherapy are recommended for patients without cervical lymph node metastases.
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Based on transversely isotropic theory, a finite element model for three-dimensional solid-liquid coupling defect repair of articular cartilage was established. By studying stress state of host cartilage near the restoration interface, we identified deformation type of cartilage and discussed the cause of restoration interface cracking. The results showed that the host cartilage surface node near the restoration interface underwent compression deformation in the condition of surface layer defect repair. When the middle layer, deep layer or full-thickness defect were repaired, the node underwent tensile deformation. At this point, the radial dimension of cartilage increased, which might cause restoration interface cracking. If elastic modulus of the tissue engineered cartilage (TEC) was lower (0.1 MPa, 0.3 MPa), the host cartilage surface layer and middle layer mainly underwent tensile deformation. While elastic modulus of TEC was higher (0.6 MPa, 0.9 MPa), each layer of host cartilage underwent compression deformation. Therefore, the elastic modulus of TEC could be increased properly for full-thickness defect repair. This article provides a new idea for evaluating the effect of cartilage tissue engineering repair, and has a certain guiding significance for clinical practice.
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Objective:To investigate the application of lateral upper arm free flap in the repair of postoperative soft tissue defects after operation in the patients with tongue cancer, and to evaluate its survival rate and repair effect. Methods:Ten patients with tongue cancer, having a desire to repair soft tissue defect after tongue cancer operation, and their systemic state could tolerate the long time operation, were selected to repair tongue cancer postoperative defects with lateral upper arm flaps. Among them, 7 cases were male, 3 cases were female;aged 45-67 years old, average 52.1 years old.Radical resection of tongue cancer was primarily finished, then the flaps were designed and prepared to repair the defects of tongue according to the location and size of defects.After the operation, the survival rate of the flap was observed, and the effect of repair was evaluated according to the shape, size, volume and movement of the tongue.Results:The lateral upper arm flaps were stable and simple to prepare, the donor sites were concealed, and the upper limbs were not abnormal.All of flaps survived, and all of wounds healed primarily.The shape, size, and texture of tongues were satisfied, and the movements of tongue were not significantly restricted.After repair, the voice, mastication and swallowing function of the patients were good without obvious influence.Conclusion:The survival rate of lateral flap of upper arm is high, and the tongue shape and function were good after tongue defect repair.It is an ideal free flap for repairing the tongue tissue defect of tongue cancer after operation.
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Objective: To discuss the role of heparan sulfate (HS) in bone formation and bone remodeling and summarize the research progress in the osteogenic mechanism of HS.
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Objective To compare and analyze the advantages and disadvantages of the forearm skin flap and the lateral femoral skin flap in the repair of oral and maxillofacial defects.Methods Of the 34 patients of oral and maxillofacial tumor resection received postopera-tive reconstruction of maxillofacial defects treatment,18 patients repaired by forearm flap( forearm flap group) ,16 patients repaired by antero-lateral thigh flap ( anterolateral thigh flap group) .The clinical effect and the restoration of two groups after surgery were compared.Results The survival rate of disposable surgical flap in forearm flap group was 94.44%,the survival rate of the anterolateral thigh flap group was 87.50%.The difference between two groups was not statistically significant (P>0.05).The difference of swallowing function in 3 months after surgery between two groups was not statistically significant (P>0.05).The difference of survival quality score between the two groups was not statistically significant (P >0.05) in 6 months after surgery.The scar proliferation rate (27.78%), pigment deposition rate (88.89%), temporary sexual dysfunction rate(66.67%),a permanent disability rate (27.78%) of forearm flap group were significantly higher than those of the femoral anterolateral flap group patients (P<0.05).Conclusion The forearm skin flap and the lateral femoral skin flap have a good clincal effect on the repair of oral and maxillofacial defects,and the incidence of complications of the femoral anterior lateral femoral flap is lower.
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Objective To compare the application effects of pentobarbital sodium ,urethane and midazolam combined with ket-amine/Sumianxin Ⅱ in rabbit bone defect repair .Methods 120 healthy male adult rabbits were randomly divided into three groups according to different anesthetic agents ,40 cases in each group .The group A was intramuscularly injected by pentobarbital sodium , the group B was given urethane by the ear vein and the group C was given midazolam combined with ketamine/and Sumianxin Ⅱ by intramuscular injection .The onset time of anesthesia ,maintenance time ,breathing rate ,heart rate ,complications ,recovery time ,ad-ditional anesthetic agents and postoperative death rate in 3 groups were recorded respectively .Results The onset time of anesthesia in the group B and C was(4 .53 ± 0 .65) min and(3 .56 ± 1 .31) min respectively ,which were significantly shortened compared with the group A(P<0 .05);the maintenance time of anesthesia in the group B was (152 .12 ± 12 .53) min ,which was significantly short-ened compared with the group A and C (P<0 .05);the recovery time in the group C was (31 .05 ± 5 .73) min ,which was significant-ly shortened compared with the group A and B(P<0 .05) ,the propability of additional anesthetic agents and the postoperative mor-tality in the group C were significantly decreased compared with the group A and B (P<0 .05) .Conclusion The combined anesthe-sia of midazolam and ketamine/Sumianxin Ⅱ has definite effect without any observed intraoperative depressions of breathing rate and heart rate and with high safety ,high controllability and less influence on the long term survival of the experimental animals , which is a more ideal anesthesia method of the rabbit bone defect repair .