Interstitial high-resolution MR lymphangiography in patients with lower extremity lymphedema / 中华整形外科杂志

<p><b>OBJECTIVE</b>To assess the feasibility of interstitial magnetic resonance lymphangiography (IMRL) with intracutaneous injection of gadobenate dimeglumine--a commercially available, non-ionic, extracellular paramagnetic contrast agent.</p><p><b>METHODS</b>We studied 10 patients with lower extremity lymphedema. A mixture of 7.5 ml gadobenate dimeglumine and 0.5 ml 2% lidocaine were evenly subdivided into 8 portions and injected intracutaneously into each web space of both feet. For IMRL, a 3D fast spoiled gradient-recalled echo T1-weighted images with a fat saturation technique (T1 high resolution isotropic volume excitation, THRIVE) was performed.</p><p><b>RESULTS</b>The beaded appearance of lymphatic vessels extending from the injection site were detected in 11 of 12 lower legs and the best delineation of lymphatic vessels was present at 15-30 minutes after injection. In 6 of 12 affected thighs, lymphatic vessels could be also visualized with the strongest enhancement at 45 minutes.</p><p><b>CONCLUSION</b>IMRL is a safe and technically feasible new method which can effectively visualize the pathological lymphatic vessels in lower extremity lymphedema.</p>

Experimental study of gene therapy with human vascular endothelial growth factor-c in lymphedema / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the efficacy of gene therapy with human vascular endothelial growth factor-c (VEGF-C) on obstructive lymphedema.</p><p><b>METHODS</b>Two animal models of lymphedema were created: one in the right hind limb of adult New Zealand white rabbits and the other in SD mouse tail. Each model was randomly divided into two groups to receive intradermal injection of either VEGF-C gene (experimental group), or saline(control group). In rabbit model, the volume change of affected limb was measured. In mouse model, biopsy was performed after 3 weeks treatment to detect the expression of VEGF-C mRNA and proteins. The lymphagenesis was evaluated by immunohistochemical examination with lymphatic endothelium hyaluronan receptor antibody.</p><p><b>RESULTS</b>The volume of the affect rabbit limb decreased by (24.40 +/- 1.08) ml in experimental group, compared with (5.80 +/- 1.92) ml in control group (P = 0.0001). The expression of VEGF-C mRNA and protein increased markedly in experiment group, but not in controls. More lymphatic vessels with large caliber were seen in experiment group (P = 0.0004).</p><p><b>CONCLUSIONS</b>VEGF-C gene therapy may alleviate or treat lymphedema by inducing lyphmangiogenesis.</p>

Microvascular nasal repair using a reversed superficial temporal artery auricular flap / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>A reversed superficial temporal artery auricular flap was presented to explore a new method for reconstructing the defects of the distal nose by microsurgical techniques.</p><p><b>METHODS</b>A reversed superficial temporal artery auricular flap had been used on fifteen patients with nasal defects, including thirteen patients with alar defects and two patients with nasal tip defects. The reversed superficial temporal vessels of the flap were anastomosed with the recipient facial vessels. The size of the flap was 2.5 cm x 2. 0 cm - 4.0 cm x 2.5 cm, the length of the vascular pedicle was 5 - 8 cm, average 6.5 cm</p><p><b>RESULTS</b>The flap survived uneventfully in all fifteen patients.</p><p><b>RESULTS</b>demonstrated satisfactory symmetry between the reconstructed ala and the contralateral side as well as an excellent tip projection. The donor-site defect was minimal.</p><p><b>CONCLUSIONS</b>The reversed superficial temporal artery auricular flap offers an adequate length of vascular pedicle of the flap, it delivers a good solution to the problem of the vascular pedicle shortage of the proximal superficial artery auricular flap. This technique may become the top choice in the microvascular auricular transfer.</p>

Treatment of primary lower limb lymphedema with ultrasonic assisted liposuction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe treatment effects of primary lower limb lymphedema using ultrasonic assisted liposuction.</p><p><b>METHODS</b>Internal ultrasonic liposculpture system combined postoperative continual elastic stockings or bandages were used for reducing lymphatic burdens of the affected limbs by partly removal of lymphedematous tissues.</p><p><b>RESULTS</b>Edema regression in the affected limbs were obvious at 2 weeks postoperative and kept to stable without recurrence during 1 year follow-up.</p><p><b>CONCLUSIONS</b>Ultrasonic assisted liposuction combined with elastic compression is safe and effective for the treatment of primary limb lymphedema.</p>

Reconstruction of nasal defects using a reverse preauricular flap by microsurgical technique / 中华整形外科杂志

<p><b>OBJECTIVE</b>This article reports the design and application of a free reverse preauricular flap for one-stage reconstruction of nasal defects.</p><p><b>METHODS</b>A preauricular flap was designed according to the nasal defect, which was harvested with the reverse superficial temporal vessels as its vascular pedicle. The flap size ranged from 3.0 cm x 2.5 cm to 6 cm x 2 cm without any hair-bearing skin. In flap transferring, its pedicle of the superficial temporal vessels was anastomosed with the facial vessels in the nasolabial fold.</p><p><b>RESULTS</b>The flap survived uneventfully in these three patients. The defects in the distal nose were reconstructed with satisfactory results. The donor site scar was similar to that of face-lift incision.</p><p><b>CONCLUSIONS</b>This is the first report of clinical applications of the free reverse preauricular flap by microsurgical technique. Microsurgical technique allows successful transfer of this flap in a one-stage procedure. Because of its similar color and texture to the facial skin, this flap provides excellent tissues for coverage of the nasal defect. This technique may have even wider applications for other facial cutaneous defects.</p>

Repair of foot defect with a reverse fascial pedicled posterolateral lower leg flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the applications of ipsilateral reverse fascial pedicled posterolateral lower leg flap in foot defect repair.</p><p><b>METHODS</b>A fasciocutaneous flap was designed over the gastrocnemius muscle to repair the defects in the foot or the lower third of the leg. The flap was based on a perforator branch between the lateral malleolus and the Achilles tendon, coming from the vessel network of the ankle as well as the deep fascia.</p><p><b>RESULTS</b>This method was used in 6 cases, including 2 children of 5-6 years old. All the flaps survived without necrosis and venous congestion.</p><p><b>CONCLUSIONS</b>The operation is simple and a large flap over the whole gastrocnemius muscle can be raised without sacrifice of a main blood vessel. It is an excellent method for repair of the defects in the heel, medial and lateral malleolus, dorsum pedis and the lower third of the leg.</p>

Metabolism of hyaluronic acid and extremity lymphedema / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the possible influence of the impairment of lymph fluid on the metabolism of hyaluronic acid (HA) in the lymphedematous skin tissue.</p><p><b>METHODS</b>Tissue fluid was collected in lymphedematous limbs and the contralateral healthy limbs of 39 patients and HA content was measured with radioimmunoassay. The protein contents were also measured.</p><p><b>RESULTS</b>The HA contents in interstitial fluid of lymphedematous limb were significantly (8 fold) higher than that of normal limb. The protein concentration in the tissue fluid did not show significant differences between lymphedema and those with normal tissue.</p><p><b>CONCLUSION</b>The result suggests blockage of regional draining lymphatics may impairs breakdown of HA and the stagnation of HA in the limb may exert a deleterious effect on the interstitium.</p>

Repair and functional reconstruction for compound defects of proximal phalanx and dorsal skin at multiple digits / 中华创伤骨科杂志

Objective To summarize our surgical experience in repair and functional reconstruction for compound defects of proximal phalanx and dorsal skin at multiple digits,Methods Six patients with multiple digital defects were treated in our department between June 1996 and March 2005.At the first stage,free iliac bone grafts were used to repair defects of proximal phalanges and temporary syndactyly between adjacent affected fingers was created through digital palmar skin sutures.The defects were covered with free flap transfer finally.Dorsalis pedis flaps were used in four patients,a lateral arm flap in one and a lateral thoracic flap in one respectively.At the second stage,a partial debulking procedure and division of syndaetyty followed three to six months later.Additional procedures were performed in three eases to reconstruct the digital extensor function through tendon transfer.The follow-ups ranged from six months to nine years.Results The flaps survived uneventfully in the six patients postoperatively.The dorsal aspects of reconstructed fingers demonstrated an aesthetically pleasing effect after the flap debulking procedures and division of syndactyly.Follow-up X-Ray examinations showed good lilac bone union and nearly normal structure of digital bone.The distal interphalangeal extension restored to normal in the three cases after extensor reconstruction.Conclusions Iliac bone graft to repair phalangeal defects and free flap transplantation to cover skin defects can be a good treatment for compound defects of proximal phalanx and dorsal skin at multiple digits.Secondary plastic procedure may greatly improve the appearance of a reconstructed digit,and extensor re- construction the function of distal interphalangeal extension too.