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ObjectiveTo study the anatomy of the soleus muscle perforator flap and its clinical application.MethodsIn 6 cadavers specimen with 12 lower limbs,the cutaneous branches and soleus muscle perforator artery were dissected and their measurements were recorded.Fourteen patients with skin and soft tissue defects from July 2002 to October 2010 were repaired by the soleus muscle perforator flap.Of the 14 patients,eight for dorsal and anterior defects of foot,two for anterior defects of malleolus,two for hand defects,two for elbow defects.The size of the flaps was 5 cm × 6 cm - 12 cm × 20 cm.Flap success rates and postoperative course were evaluated. ResultsThe soleus musclocutaneous perforators mostly appeared within 5 - 24 cm length below the head of fibula.The diameter of the artery cutaneous perforator was( 1.08 ±0.22)mm,vena concomitants was (1.20 ± 0.32)mm.All flaps were survived completely and the wounds got primary closure in 14 cases.The flaps were not overstaffed,and their shape,texture and color were similar to normal.All of the 14 cases were evaluated as satisfactory after 6 months to 12 months follow-up. ConclusionThe free soleus muscle perforator flap is an ideal flap for repairing skin and soft tissue defects with the merit of simple procedure,minimal trauma and more physiological circulation established.
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BACKGROUND: Numerous studies have shown that the increase of reproductive activity and self-repair capacity of brain endogenous neural cells might be a valuable method to treat ischemia-hypoxia brain damage. OBJECTIVE: To study the effects of He-Ne laser irradiation on the proliferation and differentiation of endogenous neural stem cells and brain functional reconstruction in newborn rats with hypoxia-ischemia brain damage.METHODS: Newborn rats aged 7 days were prepared for hypoxia-ischemia brain damage models. From the second day of model induction, rats in the laser treatment group were subjected to He-Ne laser irradiation. Acupuncture point included Baihui (DU20) on the median parietal bone, and Dazhui (GV14) between the C7 and T1 and the median back. After the second course, the learning and memory ability of rats were tested by Y-type maze test. Then brain hippocampal sections were made and underwent immunohistochemistry for nestin and microtubule-associated protein-2.RESULTS AND CONCLUSION: In the laser treatment group, the ability of learning and memory were obviously higher than those in the model group (P < 0.05), however, compared with the sham-operated group, the difference was not obviously (P > 0.05). Compared with the sham-operated group, nestin expression in the dentate gyrus was significantly increased in the model and laser treatment groups (P < 0.05), and the increased range was greater in the laser treatment group compared with the model group (P < 0.05). Microtubule-associated protein-2 expression was widely distributed in the cerebral cortex, and darkly stained brown dendrite presented with radiation-shape. Neurons in the hippocampal pyramid and dentate gyrus granular cell layer arranged regularly. Positively stained dendrite presented branch-shape and distributed in the molecular layer. No significant difference was determined between the sham-operated and laser treatment groups. But the microtubule-associated protein-2 expression was significantly weakened in the model group. He-Ne laser irradiation can promote proliferation of endogenous neural stem cells in neonatal rats with hypoxia-ischemia brain damage, induce its differentiation into neurons, thus, achieves reconstruction of learning and memory functions.
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Objective To study the method of solving the complications of large allograft including resorption, nonunion and refracture by means of vascularization and the way of improving bone healing. Methods The bone defect longer than 10 cm of limbs were found in 21 cases, plate or external fixator were used to fix allograft bone, and then vascularied autologous bone or periosteum were transplanted or inserted to the massive allograft In order to vascularizate allograft, improve bone healing and prevent complications of bone resorption and osteolysis. 4 cases were implanted by local vascular bondle in one end. 4 cases were transplanted vascular iliac bone into middle part the allograft bone, 2 cases were into one end. 2 cases were transplanted by vascular fibular bone. 6 cases were used vascular periosteum. 3 cases were used combined methods. Results Twenty-one cases with 10 cm or more bone defect in this group were treated by the method above. 14 cases were achieved primary healing, 6 were healing by farther operation, 1 failure. Complications were found in 7 cases, 4 occur infection in all. All were achieved satisfactory function and outlook by follow-up. Conclusion The method of vascularied autologous bone or periosteum combined with massive allograft are effective to improve bone union, reduce the complication of bone resorption and osteolysis,which proved usefull to treat large bone defect.
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Objective To explore and solve the problem of insufficiency and malformation due to cripple hand and defect of digital bone resulted of innate and injured. Evaluation to the methods of bone autografting combinated with flaps to reconstruct the deficient hand and digits. Methods Vascularized iliac bone or metatarsophalangeal joints (MPJ) or toes transplantation incorporated with flaps were used to reconstruct the defected bone in palm or fingers. Combined with tendon absence in such cases should be repaired or restituted by tendon autografting in one stage or by stages. Results Total 16 cases were treated by the methods metioned above. Except 1 of 16 was failure resulted in severe infection, the others were reconstructed successfully. 13 of 16 were followed up 8 months to 2 years, the evalution of the group from motion,sensation and appearance shew that the fine rate of motion was 53.8 percent, the rate of appearance and sensation were both 69 percent. Conclusion Vascularized iliac bone or metatarsophalangeal joints (MPJ) or toes transplantation incorporated with flaps are available to reconstruct the defected bone in palm or fingers, and can reduce disability effectively while obtain a satisfactory outlook and proper functions by those methods.
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Objective To study and discuss the methods for repairation and reconstruction of foot defects in order to reduce the deformity and insufficiency of foot and to restorat its functional and cosmetic aspects. Mehtods Soft tissue recovery was enough for digital absence, dorsal, submalleolus and calcaneous defect; Delects in plantar should be repaired with pre flap; Abstence of metatarsats head should be reconstructed by using vascularized bone incorporation with free flap transplantation. Results Total 247 cases with bone and soft tissue defects of foot were recpaired by using managements mentioned above aehived satisfactory clinical result. All patiants were assed according to AOFAS of USA fool malleolus scores, excellent 84 cases; good 107; fair 42; poor 14. Conclusion Being flat in shape and abundant blood supply, the iliac bone is a valuable supply bone lor foot defects espesial for muti-matatarsal and ealeaneus. Absence of malleous should be reconstructed by free iliac bone or free febular head with fascial strip. Vascular bone incorporating with vascular flaps provided an ideal method of reconstruction foot conpound defeets.