Clinical effect of platelet-rich plasma combined with bone graft on bone defect in humeral condylar / 局解手术学杂志

Objective To investigate the effect of platelet-rich plasma(PRP) combined with bone graft in the treatment of humeral condylar bone defect.Methods A total of 135 patients with humeral condylar bone defect in Ankang central hospital from January 2012 to December 2015 were divided into the PRP combined group(n =69) and the conventional group(n =66) according to the order of admission time.The patients of PRP combined group were treated with platelet-rich plasma combined with autologous bone graft,and patients of conventional group received autologous bone graft,respectively.The surgery time,hospitalization time,wound healing,fracture union and the motion of elbow joint at postoperative 1 year between two groups were compared.The Kaplan-Meier survival curve was used to reflect the bone healing in both groups,and the log-rank test was used to compare the result.Results There was no statistically significant difference in the surgery time,hospitalization time,wound healing and motion of elbow joint at postoperative 1 year between the two groups(P ＞ 0.05).But the average time of wound healing (3.8 ± 0.72) weeks and the time of bone union (18.8 ± 3.50) weeks in PRP combined group were significantly shorter than (6.4 ±0.58) weeks and (22.7 ± 1.55) weeks in the conventional group(P =0.000),the differences were significant.The KaplanMeier survival curve of the bone union in the PRP combined group was also significantly better than that in the conventional group.Conclusion PRP can promote the healing of fracture in patients with humeral condylar bone defect after autologous bone graft,which contributes to the recovery of elbow function.

Free superficial iliac circumflex artery skin flap: the clinical application and management of donor site defects / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of free superficial iliac circumflex artery skin flaps, as well as the management of donor site defects.</p><p><b>METHODS</b>17 free superficial iliac circumflex artery skin flaps were applied for the traumatic defects or deformities on face, neck, foot, hand, ankle and lower leg, respectively. The donor site defects were closed directly or covered by paraumbilical island flaps.</p><p><b>RESULTS</b>The 17 flap size ranged from 5 cm x 3 cm to 19 cm x 14 cm. 16 flaps survived completely except 1 flap with partial necrosis, which was closed by free skin graft. The donor site defects were closed directly in 10 cases, and covered by paraumbilical island flaps in 7 flaps without no flap necrosis. The abdomen had a good appearance.</p><p><b>CONCLUSIONS</b>Good appearance can be achieved with free superficial iliac circumflex artery skin flaps for the defects on face, neck, foot, hand, ankle and lower leg. Paraumbilical island flap can be used for the donor site defects.</p>

Systemic therapy for defects of skin and soft tissue on the knees after severe trauma or burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the methods of systemic treatment of defects of skin and soft tissue on the knees after severe trauma or burn.</p><p><b>METHODS</b>Twenty patients with defects of skin and soft tissue on the knees after severe trauma or burn hospitalized in our center from January 2009 to December 2011. The injury areas on the knees ranged from 5 cm×4 cm to 30 cm×20 cm. The wounds were treated with radical debridement, vacuum sealing drainage, and douche through dripping to control infection in early stage. Then they were covered with transplantation of skin grafts plus flap or only with flap. Totally 8 local flaps (including 6 local rotation or transposition flaps and 2 saphenous artery flaps) and 12 free flaps (including 8 anterolateral thigh flaps and 4 latissimus dorsi musculocutaneous flaps) were used. The flap size ranged from 6 cm×5 cm to 32 cm×22 cm. The rehabilitation training of the knee joints was carried out in the early stage after wound healing.</p><p><b>RESULTS</b>All free skin grafts and flaps used in 15 patients survived. Thirteen of them were primarily healed, while some small parts of skin grafts of the other two patients were in poor condition because of infection, and they healed after another session of skin transplantation. Infection occurred under the free flap in one of the 5 patients transplanted with flaps only, which was healed after continuous douche through dripping and another surgical debridement following wet dressing. The knee joints were in good function during the follow-up period of 1 - 3 years.</p><p><b>CONCLUSIONS</b>The systemic therapy of radical debridement, vacuum sealing drainage technique, douche through dripping, transplantation of large autologous grafts and flaps, and the early rehabilitation training are effective and reliable in repairing defects of skin and soft tissue at the knee region after severe injuries.</p>

Repair of devastating wounds with free composite tissue flap / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the safety and effects of free composite tissue flaps in repairing devastating wounds in early stage.</p><p><b>METHODS</b>One hundred and twenty-three patients with 128 devastating wounds hospitalized in our burns center from 2005 to 2009 were repaired with free flaps or composite tissue flaps. Flap types used included 58 latissimus dorsi muscular flaps, 32 anterolateral thigh flaps, 21 circumflex scapular flaps, 6 dorsalis pedis composite flaps, 3 big toe nail skin flaps, 3 forearm flaps, and 1 lateral thoracic flap. One wound was repaired with lateral lower leg flap with fibula, and 3 wounds with free latissimus dorsi muscular flap plus skin graft.</p><p><b>RESULTS</b>Vascular crisis was observed in 10 transplanted flaps 1 to 5 days after operation; 6 flaps with this complication were saved after emergency surgical exploration. Total survival rate of transplanted flaps and composite tissue flaps was 95.3% (122/128). All patients were followed up for 3 months to 4 years; satisfactory appearance and restoration of partial function were found in all of them.</p><p><b>CONCLUSIONS</b>Free composite tissue transplantation reduces amputation rate, achieves primary reconstruction of function with good appearance, shortens length of hospital stay, and reduces surgical operation time, complications, and treatment cost. It is a good approach in the repair of massive devastating soft tissue injury.</p>

Surgical therapy for massive deep skin and soft tissue injuries / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the methods of repair of massive deep skin and soft tissue injuries.</p><p><b>METHODS</b>Fifty-six patients with deep skin and soft tissue injuries were hospitalized from July 2006 to January 2008. Among them, 23 cases were caused by burn, 17 cases by electric injury, 7 cases by hot crush injury, 6 cases by avulsion injury, and 3 cases due to other reasons (including traffic accident, crush injury, soft tissue infection respectively). Sixty-five skin flaps were raised to repair and reconstruct the injured tissues, including 21 local flaps, 18 distant pedicled skin flaps, and 26 free skin flaps. The area of skin flaps ranged from 1.5 cm x 1.0 cm to 39.0 cm x 23.0 cm.</p><p><b>RESULTS</b>Sixty skin flaps survived completely, partial necrosis occurred in 3 flaps, and complete necrosis in 2 flaps. There was no obvious difference in average survival rate among local skin flaps (95.2%), distant pedicled skin flaps (88.8%), and free skin flaps (92.3%, P > 0.05).</p><p><b>CONCLUSIONS</b>Skin flap transposition can be still considered as the major effective method in repair of massive deep skin and soft tissue injury. On the premises of high survival rate, free skin flap transposition can be considered as the first choice.</p>

Reproduction of a model of heat injured keratinocyte in vitro and observation on its apoptosis rate / 中华烧伤杂志

<p><b>OBJECTIVE</b>To reproduce a model of heat injured KC in vitro and explore its apoptosis rate of KC due to heat injury at different temperature.</p><p><b>METHODS</b>Human KCs were cultured in vitro, and they were incubated at 37, 41, 43, 45, 48, and 51 degrees C respectively for 10 mins in water bath. Trypan blue staining and Hoechst 33258 fluorescence staining were used respectively to determine necrosis and apoptosis of KC. Rates of apoptosis and necrosis of KC were analyzed quantitatively by flow cytometer. The proliferation activity of KC after heat injury was detected by MTT test.</p><p><b>RESULTS</b>The results of trypan blue staining, Hoechst 33258 fluorescence staining, and flow cytometer demonstrated that number of apoptotic and necrotic KC increased gradually along with a rise of water bath temperature. The rates of apoptosis and necrosis of KC were respectively (12.3 +/- 3.2)% and (14.1 +/- 1.6)% at 45 degrees C, (27.7 +/- 5.1)% and (58.0 +/- 4.2)% at 48 degrees C. Rate of KC necrosis reached up to (83.0 +/- 5.3)% at 51 degrees C. Inhibition of KC growth reached a stationary phase when the injurious temperature reached 45 degrees C as observed with MTT test.</p><p><b>CONCLUSIONS</b>Heat injury can induce apoptosis and growth inhibition of KC in vitro. Incubating KC at 45 degrees C for 10 mins is a good condition to reproduce a model of heat injured KC in vitro. This model may be used to study the biological character and apoptosis of KC after burn injury.</p>

Application of lavation and drainage with continuous negative pressure in the debridement of diabetic foot complicated by plantar abscess / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of debridement at early stage by combining lavation and drainage under continuous negative pressure in the limb salvage surgery of patients suffering from diabetic foot complicated by plantar abscess.</p><p><b>METHODS</b>Ten patients suffering from diabetic foot (10 feet affected) combined with plantar abscess were involved. After being debrided, wounds of patients were lavaged and drained for 7 - 14 ds under continuous negative pressure through a detained stomach tube. Suction under negative pressure continued for 3 - 5 ds after lavation, and then drainage tube was removed. Stitches on wound were removed about 3 weeks after surgery. The condition of the wounds was observed.</p><p><b>RESULTS</b>After above-mentioned treatment, local inflammatory response of patients was obviously ameliorated, and the wounds healed with satisfactory preservation of function and shape of the feet.</p><p><b>CONCLUSIONS</b>Debridement combined with local lavation and drainage under continuous negative pressure is satisfactory for the treatment of diabetic foot complicated by plantar abscess, and it can preserve the length of the affected limb.</p>

Evaluation and surgical treatment for chronic wound of leg and foot / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the optimal operation method for the management of various chronic wounds in legs and feet.</p><p><b>METHODS</b>Fifty-one chronic wounds were evaluated according to infection, inflammatory response, and distribution in different areas of the leg and foot. Preoperative treatment was given accordingly, then transposition of skin flap, skin grafting, or amputation was performed. The healing rate after single session operation and average hospitalization were statistically analyzed.</p><p><b>RESULTS</b>The wound healing rate after single session operation was 86. 3% , the average hospital stay was (17. 8 +/- 2. 1) days, and the appearance and function of the leg and foot after operation was satisfactory.</p><p><b>CONCLUSION</b>The appropriate preoperative treatment and operation method conforming to the wound location and evaluation are of vital importance in the management of chronic wounds in the leg and foot. Operation is one of the most effective ways to repair chronic wounds in the leg and foot, and it can shorten the wound healing process and restore the function.</p>

The study on EPC originated from human umbilical cord blood promoting neovascularization in ischemic skin flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>Injecting the EPC into the corresponding skin flap to study EPC biological characteristics and its effect on neovascularization in ischemia skin flap.</p><p><b>METHODS</b>CD133 + cells were enriched from human umbilical cord blood by immunomagnetic sorting, and cultured with EGM - 2MV media. After labeled with PKH26 (fluorescent cell linker), the EPC were injected into the over-length flap models made on athymic mice. Observing the EPCs trace and their participating in the flap vascularization using a fluorescent microscope. The potential of EPC neovascularization in ischemic tissue of skin flap was evaluated through measuring the necrotic area and vessel diameter and quantity in the skin flap.</p><p><b>RESULTS</b>The skin flap necrosis area of EPC group is significantly smaller than that of control (P < 0.05), the dermal and hypodermal blood perfusion of EPC group is significantly more than that of control (P < 0.05). Immunohistological and label fluorescent analyses showed vWF antigen-positive cells and labeled cells constructing blood vessels of flap.</p><p><b>CONCLUSIONS</b>Our data support the EPC may contribute to angiogenesis, speed up ischemic tissue vascularization.</p>

Purification, identification and oriented differentiation of endothelial progenitor cells from human umbilical cord blood / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the endothelial progenitor cell markers and biological characteristics of human CD133 umbilical cord blood cells( EPC).</p><p><b>METHODS</b>CD133+ cells were enriched from human umbilical cord blood by immunomagnetic sorting, and cultured with EGM-2MV medium containing epidermal growth factor, vascular endothelial growth factor and fibroblast growth factor 2. The percentage of CD133+ cells in cord blood monocytes, the growth curve and growth characteristics of primary EPCs were measured by flow cytometry and immunochemistry method. Weibel-Palade body was observed with transmission electron microscope. The mixture of EPCs and human stomach cancer cell line GC7901 were injected into athymic mice to observe the tumor growth and vascularization.</p><p><b>RESULTS</b>The percentage of CD133+ cells in cord blood monocytes was 0.91%, and after sorting, the percentage of CD133+ cells was raised to 85.52%. The cultured cells showed a typical spindle-shaped morphology in 3 post-culture days (PCD) and areas of clusters of cobblestone-like cells in 10 PCD. The number of EPC increased from 7 PCD on, peaked on 17 PCD. Obvious amplification and clone-like growth on 7 PCD were observed by light microscope. Typical Weibel-Palade body was observed in the cells under transmission electron microscope. Tumor forming experiment in athymic mice showed that the tumor size of EPC group was larger than that of control with smaller necrosis area and more and larger blood vessels. Immuno-fluorescent staining showed many human vWF antigen-positive endothelial cells being involved in the tumor vascularization.</p><p><b>CONCLUSION</b>Immunomagnetic sorting can efficiently enrich EPC from human umbilical cord blood. Our data support that the EPC may contribute to angiogenesis, speed up vascularization of ischemic tissue.</p>

In vitro isolation, cultivation and identification of sebocytes and eccrine sweat gland cells from human fetal skin / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the preliminary methods of in vitro isolation, culture and identification of sebocytes and eccrine sweat gland cells from human fetal skin.</p><p><b>METHODS</b>Human fetal skin was digested with dispase or type II collagenase, and then by micro - sieving to isolate human sebaceous gland and eccrine sweat gland cells. DMEM/F12 (1: 1) was used as the basic culture medium, supplemented with fetal bovine serum, recombinant human epidermal growth factor, L-glutamine, Hydrocortisone, choleratoxin, penicillin and streptomycin as the medium for sebocytes, or fetal bovine serum, recombinant human epidermal growth factor, triiodothyronine, hydrocortisone, insulin, transferrin, sodium selenite to the medium for eccrine sweat gland duct cells. Primary cultures and subcultures were incubated at 37 degrees C in humidified atmosphere of 5% CO2/95% oxygen. Cell morphology was observed by inverted phase contrast microscopy, and the cultured cells were identified with cell clone efficiency determination. The cultured sebocytes were identified with oil red staining and CK4.62, Epithelia Membrane Antigen (EMA) immunohistochemistry staining. The cultured eccrine sweat gland duct cells were identified with CK7, CK19 immunohistochemistry staining.</p><p><b>RESULTS</b>The isolated sebocytes and eccrine sweat gland cells from human fetal skin could grow by adhering to the wall and proliferate in vitro. The cell clone efficiency of human fetal sebocytes was 2.7%, which was obviously lower than that of human fetal keratinocytes (8.0%, P < 0.01). There was no obvious difference in the cell clone efficiency between human fetal eccrine sweat gland cells (7.3%) and human fetal keratinocytes (7.7%, P > 0.05) . The results of oil red staining indicated that a small quantity of lipid droplets in sebocytes, and immunohistochemistry staining of CK4.62, EMA were positive in subculture sebocytes. The immunohistochemistry staining of CK7, CK19 was positive in subculture eccrine sweat gland duct cells.</p><p><b>CONCLUSION</b>In vitro cultured human fetal sebocytes and eccrine sweat gland duct cells displayed the markers and biological characteristics of epithelial lineage, but human fetal sebocytes proliferated more</p>