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Objective To evaluate the clinical effects of simple external skin expansion technique in treatment of skin necrosis defect after the surgery for Pilon fracture.Methods Data of 12 patients with skin necrosis defect after the surgery for Pilon fracture treated with simple external skin expansion technique in our hospital from May 2015 to January 2017 were retrospectively analyzed.There were 10 males and 2 females in the 12 patients with age 32-58 years old(average 45.30± 8.91 years old).There were 4 cases with open fractures and 8 cases with closed fractures.The defect area was about 9.1 cm long and 3.9 cm wide.There were 3 cases with skin necrosis of open fractures and 9 cases with postoperative skin necrosis of incision site. After completely debridement and removing infection from the skin necrosis areas, kirschner needle wired intermittented through the skin,the kirschner wire was around a sterile silicone rubber tube at both ends and the kirschner wire was connected to the both ends of the Kirschner on the opposite side.After giving moderate tensile force,which showed that the skin on both sides was still bleeding,no obvious pale color on skin,two ends of rubber tube were fixed with forceps. Using the ductility of skin and the tensile force of sterile silicone rubber tube to gradually extend the skin and to gradually narrow and close the suturing wound.All patients were followed up for 3-6 months to observe the effect of surgery.Results All of the 12 cases were healed in 2-4 weeks,average(2.50±0.59)weeks.The patients were sutured directly after simple external skin expansion,and 4 patients were sutured with the surface of the external plate or tendon,and parts of wound were delayed healed after the re-suture.The skin color,lustre,hair growth and elasticity were normal,no bloated,and tenderness was normal after simple external skin expansion.Conclusion The simple external skin expansion technique in treatment of skin necrosis defect after the surgery for Pilon fracture is a simple,effective and economic method,which is worthy of clinical promotion.
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Objective To observe the effect of botulinum toxin type A (BTX-A) on the rate of skin expansion and the immediate retract rate of skin flaps in rats,and to explore new methods for drug-assisted skin expansion.Methods 18 Sprague-Dawley rats were randomly divided into two groups.After BTX-A or normal saline was injected intradermally into the back marking area,an expander was implanted.The expanders were inflated periodically by injecting normal saline to reach the designated intraexpander pressure.The inflation volume was recorded and the area of marked region was measured regularly.After 4 weeks of expansion,the expanded tissues were harvested and the immediate retract rates were measured.The hematoxylin-eosin staining was performed to observe the thickness of epidermis,dermis and the fibrous capsule,while Masson staining for detection of fibrous capsule collagen.Immunohistochemical staining with α-smooth muscle actin for myofibroblasts was also performed.Results The mean inflation volume and area of marked region of BTX-A group were significantly greater than those of the control group.There were lower immediate retract rate,thinner fibrous capsule,less collagen content and fewer α-SMA positive myofibroblasts in the fibrous capsule of the BTX-A group with statistically significant differences (P ＜ 0.05).There was no signigicant difference in the thicknesses of epidermis and dermis between the two groups (P＞0.05).Conclusions BTX-A can inhibit the formation of fibrous capsule to promote skin expansion,while reducing the immediate retract rate.It possess a potential for assisting effectively skin expansion.
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Objective To explore the effect of skin expansion by B- mode ultrasound with modified Seldinger technique (MST) on preventing puncture site bleeding after the catheterization in breast cancer patients. Methods One hundred chemotherapy breast cancer patients who need to be catheterized PICC were recruited to participate in a randomised controlled trial in Tianjin Medical University Cancer Institute& Hospital, China. Fifty were assigned to the experimental group (using Intra- thecal intubation sheath), and 50 were assigned to the control group (expansion skin by scalpel). The two groups used modified Seldinger technique (MST) during the procedure of ultrasound guided PICC insertion, Patients errhysis and average frequency of dressing- change were collected for 1 week since catheterization to compare the effects of the two methods. Results Patients′errhysis and average frequency of dressing- change were (0.491±0.241) ml, (1.060±0.239) times in the experimental group, significantly lower than (2.903±1.046) ml, (3.500±0.646) times of the control group (t=15.889, 25.049, P < 0.01). Conclusions This study showed a lower incidence errhysis of skin expansion by intra- thecal intubation sheath used for PICC insertion. This technique deserved clinic application in PICC.
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Objective Comparative effect of WeChat platform nursing intervention and routine nursing intervention on reducing the incidence of complications of children skin expansion in the process of external ear reconstruction. Methods 132 cases of congenital microtia received skin expander implantation at our institution from Jan 2014 to Aug 20 14 were included as control group. 122 cases of congenital microtia received skin expander implantation at our institution from Sep 2014 to Apr 2015 were included as the intervention group. Children and their families in the control group were treated with routine propaganda and education, and the intervention group were added with internet nursing intervention. Collection and analysis the family health knowledge degree and the occurrence of complications in children of the two groups. Results The score of health knowledge about skin expansion in the intervention group was (33.67 ± 2.44),which was significant higher than that of in the control group (25.07 ± 2.02), t=9.71, P < 0.01. The incidence rate of complication in the intervention group was 2.46%(3/122), which was significant lower than that of in the control group, 8.33%(11/132),χ2=4.20, P<0.05. The satisfaction rate of patients′family member in the intervention group was 95.08%(116/122), which was significant higher than that of in the control group, 84.09%(111/132 ),χ2=15.65, P<0.05. Conclusions WeChat platform nursing intervention can reduce expansion flap complications occurrence rate in the periods of expander. It is worthy of clinical application.
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Full skin auto-grafts are required for reconstruction of skin burns and trauma scars. However, currently available clinical approaches such as sheet skin graft, mesh skin grafts, artificial skin graft, and in vivo skin expansion have limitations due to their potential danger for secondary damage and scar formation at the donor site, and discomfort during skin expansion. We developed an advanced bioreactor system and evaluated its function in skin expansion using porcine full skin. The reactor was designed as a pneumatic cylinder type, was programmed to adjust the pressure and the operating time. The system was composed of culture chamber unit, environmental control unit, and monitoring unit. Skins were expanded at 200 kPa pneumatic force and the expanded skins were analyzed by immunohistochemistry and histology. Furthermore we carried out auto-grafting experiment of the expanded skins in vivo using Yucatan pigs and skins were harvested and histologically analyzed after 8 weeks. The results showed that the bioreactor expanded skins to 160% in 4 hours. Histological analysis of the expanded skins revealed that epidermal cells and dermal fibroblasts were viable and remained integrity. The results of auto-grafting experiment indicated that fibrosis and scars were not detected in the grafted skins. This study demonstrates that the newly developed skin bioreactor enabled to obtain large sized full skin rapidly and successful grating.
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Humans , Bioreactors , Burns , Cicatrix , Fibroblasts , Fibrosis , Immunohistochemistry , Skin , Skin, Artificial , Swine , Tissue Donors , TransplantsABSTRACT
Objective To investigate the feasibility of transplantation of mesenchymal stem cell (aisc) into expanion skin. Methods MSCs were isolated from porker's bone marrow and cultured in vitro. Pigs were randomly divided into four groups: Group A was injected with MSCs on the local expansion; Group B was injected with MSCs from ear vein; Group C was planted expander only; Group D was the contronl group. Each side of pig's spinal column was implanted with three expander in groups A, B and C. The same volume of NS was injected at the fixed time, the marked area measured after 7, 14, 28 days of expansion, the difference of those area was compared between groups. The differentiation of BM-MSC was detected by immunofluorescence. Results Flow-cytometric analysis showed that these BMSCs expressed CD90 and CD29 highly but did not express CD34 or CD45. The expansion area (cm2) of groups A, B, C and D was 34.05±0. 92, 31.83±l. 07,30. 10±0.79, and 18. 27±0.25, respectively (P＜0. 01). Immunofluorescence showed that the positive expression rate of CD31, PCNA in groups A and B was higher than that in groups C and D, in which the expression was the highest in group A. Conclusions Allogeneic transplantation of BM-MSC can promote skin expansion and the effect of local transplantation group is most significant.
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Objective: To understand the effects of different expansion ways on collagen and actin of skin and to provide an experiment foundation for the suitable expansion method clinically. Methods: The rabbits were divided into five groups. The expanders were embedded in experimental group. The sirius-red specific staining method was applied to observe the changes of type I collagen and type III collagen and their proportion. Immunochemistry method was used to detect the expression of actin. Results: 1: In group A, B and C, type I collagen arranged turbulently and was thicker and type III collagen decreased relatively at earlier maintaining period. After 4 week, type I collagen arranged regularly and type III collagen was relatively increased. 2: Comparisons of the area about type I, III collagen: At the same maintaining period, there were no significant difference among the group A,B and C. With the extension of maintaining period, the area of type I, III collagen increased gradually, but there was inclined to stabilize at the fourth week in group A, B and at the third week in group C. Comparison of the proportion of collagen I and collagen III: There were significant difference between group A, B and group D, but no significant difference was observed after the fourth week. There were significant difference between group C and control group, but no significant difference was observed after three week. 3. With the extension of maintaining period, the positive expression rates of actin decreased gradually in group A, B, C. At the same maintaining period, significant difference were observed among group A, B, C. The positive expression rates of actin in group C were lower than that of group A at the same maintaining period. Conclusion: The repeated rapid expansion can not only shorten the clinical period but also promote the quality of skin flap. It is a safe and feasible method in clinic.
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Objective To conduct an empirical study for quantifying the anastomosis between two vessels after skin expanded technique by the method of angiography and to provide a precise basis for vascular study in skin flap.Methods Bilateral skin flaps based on deep iliac circumflex vessels were elevated from the abdominal wall including deep superior epigastric vessels.One was expanded at the boundary between two vessels and the other unexpanded.An X-ray image was obtained by carotid arterial injection of gelatin-lead oxide mixture.Three parallel lines with equal intervals perpendicular to long axis of the two vessels were designed at the communication area.Vessel anastomosis quantity was determined by counting the number of marks derived from the intersections of the lines and the vessels and statistical analysis was carried out.Results The marks of intersection in expanded group were more than unexpanded group with statistical significance.Conclusions The method for quantifying vessel anastomosis in skin flap is reliable.The principles of this procedure may also be applied to other experimental and elinical studies.
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Objective To summarize overlapping tissue expansion of neck without platysma in repairing maxillofacial and neck scar contracture deformity.Methods Two expanders were buried in the same soft tissue pocket superficially to the platysma in an overlapping pattern,water injection were on schedule,and secondary operation was performed after 4 to 6 weeks.Results 16 cases of maxillofacial and neck scar contracture deformities were treated with overlapping tissue expansion of neck without platysma since 2004.Good results were achieved except one case of expander exposure,but the final resuit was good after suitable treatment.Conclusion The overlapping tissue expansion technique can provide much more expanded tissue and reduce complications compared with the traditional expansion technique,especially using overlapping tissue expansion of neck without platysma for repairing the defects at the maxillofacial and cervical region.
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Objective To study a simple surgical method for continuous rapid tissue expansion and its clinical application. Methods The operation was accomplished in two-stage procedures. First, expanders were placed in the subcutaneous pocket through interlesional perpendicular short incisions. Continuous expansion by trace syringe pump began from the second day after expander placement. The speed of water injection was set according to patient's algesthesia reaction and vascularity of skin. The second operation was carried out at the third to fifth day after the expansion completed.Results The method was put into clinical practice in 22 cases (16 cases of scar, 2 cases of capillary angioma, and 4 cases of black nevus), and 35 expanders were placed. The speed of water injection was set in 0.2～0.8ml/hr/100ml.The mean time of water injection was 15.3 days. In the process of expansion, all cases were satisfactory except 1 case, in which the expander exposed in the incision. After the second operation, all flaps survived except one showing distal skin necrosis. The result was satisfactory after 3 months to 1 year follow-up. Conclusion The procedure consists of expander placement through interlesional perpendicular short incisions and continuous expansion in advance, which maximally shortens the time of expansion and hospitalization. This expansion method is a simple, safe, reliable, and ideal rapid tissue expansion technique.
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The hemifacial giant congenital nevus is a rare lesion but it always places a substantial challenge in the hand of the plastic surgeon. Surgical early management of these lesions is recommended and established by the use of tissue expansion and combined full-thickness skin grafting. Although the use of serial tissue expansion for the burn scars and the giant pigmented nevi of the trunk was recently presented, but this technique has not been reported for the reconstruction of the hemifacial congenital nevus in the literature. This case illustrates a successful surgical management of a serial tissue expansion and full-thickness skin grafting for hemifacial congenital nevus.