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Objective:To observe the long-term effect of repairing soft tissue defect of the digital palmar with medial plantar artery perforators flap.Methods:From January, 2012 to February, 2015, 15 cases of digital palmar soft tissue defect were selected clinically, including 8 cases with phalangeal fracture, 5 cases with flexor tendon injury, and 9 cases with digital artery and nerve injury. The soft tissue defect area was 7.0 cm×2.5 cm-2.4 cm×3.0 cm. The medial pedis perforators flap with deep branch of medial plantar artery as pedicle and terminal cutaneous branch of saphenous nerve was cut out. The artery of the flap was anastomosed with the digital artery or common digital artery, 1 accompanying vein or superficial vein was selected to anastomose with the dorsal digital vein, and the cutaneous nerve was anastomosed with the digital nerve or common digital nerve. The perforating point, number, source of perforating vessels and the length of vessel pedicle were observed during the operation, and the color, shape, stability and TPD of the flap were observed through long-term followed-up. The good and excellent rate of the affected finger was evaluated and whether there was obvious scar, abnormal sensation and abnormal walking gait in the donor area.Results:All flaps survived and the wounds healed in one stage. All 15 patients were followed-up for 36-72 months, with an average of 48.5 months. The color and thickness of the flap were similar to that of the normal digital palmar, and the flap was wear-resistant, stable and strong in holding. The TPD was 9-12 mm. Twelve patients had transverse finger striations at the interphalangeal joint. According to the Trial Standard of the Function Evaluation of the Upper Limb of the Hand Surgery Society of Chinese Medical Association, 10 cases were excellent, 4 cases were good, 1 case was acceptable, and the good and excellent rate was 93.3%. There was no painful scar or abnormal sensation in the donor area. The ankle and foot function was good, and the gait was normal.Conclusion:The thickness, color and texture of the medial pedis perforator flap are similar to that of the palmar skin, and it is an ideal choice for repairing the palmar skin defect.
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BACKGROUND:The relationship between placing time after stem cel preparation and cel survival is the basis of safety and effectiveness for the clinical application. OBJECTIVE: To observe effects of different preservation solutions and different storage time on survival rate of umbilical cord-derived mesenchymal stem cels, and to provide important evidence for identifying effectiveness of stem cels. METHODS:Umbilical cord-derived mesenchymal stem cels were selected to prepare stem cel preparation, which was preserved in physiological saline, medium, medium+physiological saline, physiological saline containing epidermal growth factor, and medium containing low molecular heparin calcium suspension. Cold closet was selected for imitating celular transport conditions. Samples were obtained at 0, 6, 12, 18, 24, 30, 36, 42 and 48 hours. Total cel number and cel survival rate were detected. RESULTS AND CONCLUSION:The difference in cel number and survival rate was not great within 24 hours in each group. Twenty-four hours later, total cel number and survival rate were better in the medium and medium containing low molecular heparin calcium groups than in the physiological saline containing epidermal growth factor, physiological saline, and medium+physiological saline groups. These findings suggest that after stem cel preparation, the cel survival rate can reach more than 90% within 24 hours under refrigerated transport conditions. Nutritional ingredients and proper pH value of preservation solution can make the cel survival rate increased greatly.
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BACKGROUND:Different sources of stem cells have different molecular characteristics and growth characteristics;therefore, there are some differences in therapeutic mechanisms and effects. OBJECTIVE:To compare mesenchymal stem cells growth characteristics form two sources. METHODS:Mesenchymal stem cells from the umbilical cord and the embryonic liver were isolated and cultured. Passage 5 cells were used to observe the cellmorphology, calculate the doubling time of cellpopulation-doubling time, identify surface markers and determine the differentiation capacity. Mesenchymal stem cells from the umbilical cord were subcultured to passages 10 and 15, and cellcurves were drawn and population doubling time was calculated. RESULTS AND CONCLUSION:Mesenchymal stem cells from these two sources in logarithmic phase were fusiform and grew spiral y with osteogenic, adipogenic, and chondrogenic capacities. The growth curves of cells were both S-shaped. At passage 5, the doubling time was (34.37±0.31) hours for embryonic liver-derived mesenchymal stem cells and (35.63±0.38) hours for umbilical cord-derived mesenchymal stem cells, and there was no significant difference (P>0.05). However, the population doubling time of passages 10 and 15 umbilical cord-derived mesenchymal stem cells was (52.6±0.53) and (53.27±0.92) hours, respectively, which was significantly difference from that of passage 5 cells (P<0.05). The cellmorphology and growth curve from two sources are basical y the same. Embryonic liver-derived stem cells are smal er and proliferate faster than umbilical cord-derived mesenchymal stem cells, but no statistical difference is found between the two types.
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To evaluate the clinical therapeutic effect of the autologous bone marrow mesenchymal stem cells grafting integrating blood plasma transplantation in treatment of problematic nonunion. In March 2000, a 29-year-old man presented complaints of painful walking of left thigh after a velocity injury, was selected. Radiography revealed a left femoral shaft fracture, and the bone defect distance was 5 mm through X-ray examination before operation. Following a series of reposition, fixation, intramedullary nail fixation and twice autogenous lilac bone graft treatment, external fixator and autogenous lilac bone graft treatment, totally four times, the fracture was not healed. He come to Orthopaedic Surgery Department of Siping Central Hospital to accept the autologous bone marrow mesenchymal stem cells grafting integrating blood plasma transplantation in March 2008. Under the small C-arm X-ray perspective, 4 mL bone marrow-derived mesenchymal stem cells suspension integrating 10% autologous blood plasma was injected vertically into fracture site from the skin in front of the thigh with epidural needle, and the stem cells density was 1.8 × 107 cells/L. X-ray examination was performed though out-patient recheck to observe fracture healing. Two months after graft, radiography results showed fracture interspace reduced, left femoral shaft callus was continual and fracture lines blurred partly of the left femur; furthermore, left femoral shaft fracture lines blurred, and continuous bone callus formation of the left femur at 4 months after graft; The left femur achieved bone union within 7 months. The patient was returned to full weight bearing walking and good function with a fully healed femoral bone, without any fever or infection. Percutaneous transplantation of autologous bone marrow stem cells for treatment of problematic nonunion has the satisfactory result.