Anatomy and clinical application of posterior calf fasciocutaneous flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the blood supply and the clinical application of the posterior calf fasciocutaneous flap for repairing the frontal defect of knee joint.</p><p><b>METHODS</b>Based on the article review and the anatomical study of the posterior calf in 8 cadavers (16 sides), 10 cases with frontal defects of knee joints were repaired with island fasciocutaneous flaps which had pedicles of lateral superficial sural artery and the lateral sural nerve.</p><p><b>RESULTS</b>The anatomical study showed there were three systems of superficial sural blood supply- medial, middle and lateral systems. They are originated from popliteal artery or from the bilateral sural artery. The lateral superficial sural artery was present in 100% of the cadavers. The flaps survived completely in 9 cases, except one case with partial necrosis at the one-fourth distal end of the flap. The patients were followed up for 6-12 months with good aesthetic and functional results.</p><p><b>CONCLUSIONS</b>The posterior calf island fasciocutaneous flap has an reliable blood supply and protective sense nerve. The flap is ideal for the reconstruction of soft tissue defect around knee joint.</p>

Clinical analysis of complications of polyacrylamide hydrogel injection for augmentation mammoplasty in 118 cases / 中华整形外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical manifestations and explore suitable treatments for the complications induced by polyacrylamide hydrogel(PAHG) injection for augmentation mammoplasty.</p><p><b>METHODS</b>The symptoms, physical signs and treatments of the 118 cases were analyzed and summarized.</p><p><b>RESULTS</b>The complications included in nodule formation (54.2%), pain (33.9%), PAHG migration (7.6%) and acute mastitis in lactation (4.3%). Satisfactory clinical treatment results have been obtained after suitable treatments.</p><p><b>CONCLUSIONS</b>The complications induced by PAHG injection for augmentation mammoplasty have increased following its widely use, the re-evaluation for this technique should be made, and more effective treatment should be considered.</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>

Basic research and clinical application of musculocutaneous perforator flaps / 上海第二医科大学学报

The use of flaps for plastic and reconstructive surgery is very popular today.More and more surgeons have realized that the blood supply plays an important role in the design and survival of flaps.After Ian McGregor and Ian Jackson first introduced the axial flaps into clinics,Mathes divided the flaps into two types in 1981,the fasciocutaneous perforator flaps and musculocutaneous perforator flaps.In 1989,the concept of perforator flap was first brought into clinical practice.With the development of microsurgery and anatomy,the epidermis of human skin is divided into areas based on the vascular anatomy.A new century of musculocutaneous perforator flaps has been established.The terminology,classification,characteristics and application of musculocutaneous perforator flaps are described in this paper.

Construction and clinical application of tissue engineered epidermal membrane / 中华整形外科杂志

<p><b>OBJECTIVE</b>To Construct tissue engineered epidermal membrane for promoting healing of clinical skin graft donor site wound.</p><p><b>METHODS</b>Epidermal cells /Chitosan-Gelatin (CG) membrane was constructed with cultured human epidermal cells(EC) and CG membrane, at the donor site of split skin graft, the wound was divided into three groups: the control group was covered with CG membrane without KC, KC/CG membrane was grafted on the treatment part of the wound area, and blank group was covered with traditional vaseline gauze. The engineered epidermal membrane and its effect on wound were evaluated with gross observation, HE, immunohistochemistry, collagen type I/III ratio by picrosirius polarization method and RT - PCR test at various time points before and after operation.</p><p><b>RESULTS</b>The result showed that human tissue engineered epidermis could be constructed with cultured human EC and CG membrane, and this artificial epidermal membrane could be used for promoting the healing of skin graft donor site wound successfully (16 cases with 3 months' oberservation). The average healing time is (16.2 +/- 3.8) days for control group, (8.1 +/- 1.3) days for experimental group and (23.0 +/- 5.7) days for blank group. The artificial epidermis was well survived with normal structure. In addition, less hypertrophic scar development was observed in treated wound at 90 days (3 in 16 cases, 20.0%) than in the blank sites (11 in 16 cases, 74.4%). The difference is statistically significant (chi2 = 8.127, P < 0.01).</p><p><b>CONCLUSIONS</b>The constructed EC-CG membrane can be constructed in vitro, survived in vivo and has good clinical application in promoting healing of skin graft donor site wound and inhibiting hypertrophic scar formation.</p>

Microsurgical reconstruction of the nasal subunit defects / 中华整形外科杂志

<p><b>OBJECTIVE</b>The nose is composed of several delicate subunits, some of which are difficult to reconstruct if they have been injured. The paper presents the microsurgical technique to repair the nasal subunit defects with the free combined preauricular and auricular flap which well match the nasal tissues in texture, contour and color.</p><p><b>METHODS</b>The nasal subunit defects were repaired with the combined preauricular and auricular flap which were vascularized by the superficial temporal vascular system. The flap was harvested from the contralateral preauricular and the region of helix crus. The superficial temporal vessels were anastomosed to facial vessels via the vascular grafts harvested from the lateral circumfluent femoral vessels, which were about 10 to 14 cm in length. The helix crus of donor ear was reconstructed with the post-auricular flap.</p><p><b>RESULTS</b>28 cases were treated, including 3 cases of nasal tip defects, 9 cases of combined nasal alar and sidewall defects, and 16 cases of nasal alar defects. In these cases, the size of the subunit defects varied from 2.5 cm x 1.5 cm to 4 cm x 2.5 cm. 27 cases were successfully repaired with satisfactory results. The contour of reconstructed helix crus in donor site was acceptable. No walking dysfunction of the donor thigh was complained. There is one failed case, and the possible reason is the insufficient blood perfusion to the flaps, which may due to the patient's longtime-smoking status and the hypertension.</p><p><b>CONCLUSIONS</b>The technique of free combined preauricular and auricular flap is ideal for the reconstruction of nasal subunit defects.</p>

Application and review of the reversed posterior interosseous artery flap in 78 clinical cases / 中华整形外科杂志

<p><b>OBJECTIVE</b>To assess and review the indications and methods of the reversed posterior interosseous artery flap for repairing soft tissue defects of the hand.</p><p><b>METHODS</b>In the series, three types of flaps were utilized including the reversed posterior interosseous artery flap, the expanded reversed posterior interosseous artery flap and the reversed posterior interosseous artery conjoint flap. 78 clinical cases were treated with this method, in which 12 cases used the expanded reversed posterior interosseous artery flap and 10 cases used the reversed posterior interosseous artery conjoint flap. The flap,ranged from 8 approximately 6 cm to 14 approximately 8 cm, was used to repair the defects of the dorsal hand as far as to the fingerweb. The anatomy of the posterior interosseous artery was observed in the surgical dissection.</p><p><b>RESULTS</b>The posterior interosseous artery was consistently identified in all the 78 cases. In 4 cases, the artery terminated in the middle third of the dorsal forearm, therefore an alternative method of reconstruction was used. In the 53 cases of reversed posterior interosseous flaps, 49 cases healed uneventfully and 4 cases suffered necrosis in the distal border of the flap, but subsequently healed spontaneously. 12 cases of expanded flaps survived well and the donor sites were directly approximated. In the 9 cases of conjoint flaps based on the posterior interosseous artery, 7 cases healed uneventfully and 2 cases suffered delayed healing because of flap necrosis of the distal part. The satisfactory appearance and hand function were achieved postoperatively in all cases.</p><p><b>CONCLUSIONS</b>The flap is a better choice for repairing the soft tissue defects of the hand. The different type of flaps can be selected to meet the clinical requirements of reconstruction. It is suggested that the artery variation should be assessed preoperatively.</p>

Effects of hVEGF cDNA on random skin flap via a replication-deficient adenovirus vector / 中华整形外科杂志

<p><b>OBJECTIVE</b>The purpose of this study was to determine the effects of local delivery of vascular endothelial growth factor( VEGF) transferred with adenovirus-mediated gene on the survival of ischemic random skin flap in rats.</p><p><b>METHODS</b>The animals were divided into three groups randomly (n = 10) . A 2 cm x 8 cm dorsal skin flap was designed with the pedicle at the level of the iliac crest. In group A (AdCMV-VEGF), each animal received 10(12) PR replication-deficient recombinant adenovirus (AdCMV-VEGF) in the distal two-thirds of the proposed flap by means of the subdermal injection at ten different locations. In group B (AdCMV-GaI), each received 1012 PR AdCMV-Gal. In Group C (Saline), each received 1 ml saline. Three days after the treatment, the flap was elevated as planed way and re-sutured back to its donor site. All the animals were evaluated 7 days after the operation.</p><p><b>RESULTS</b>The mean percentage of surviving flap area was (85.91 +/- 2.54)% in group A, (59.56 +/- l.18)% in group B, and (61.48 +/- l.09)% in group C. There was a significant increase in the percentage of the survival area in the flaps of the group A, compared with the group B and group C (Group B vs. Group A, P < 0.01; Group C vs.Group A, P < 0.01, Group B vs. Group C, P >0.05). Hybridization in the situ, the immunohistochemical stain showed that the VEGF was expressed in the survival tissue of the flap treated with the AdCMV-VEGF, but it was not found in the control groups. Histological analysis demonstrated qualitatively greater amount of granulation tissue and angiogenesis was found in the group treated with the AdCMV-VEGF than the controls.</p><p><b>CONCLUSIONS</b>The results may indicate that Ad vector carrying VEGF cDNA could be useful in enhancing the survival of the skin flap due to the effect of the local delivery of the VEGF.</p>

Effect of adenovirus-mediated gene transfection of vascular endothelial growth factor on survival of random flaps in rats / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the effect of local application of vascular endothelial growth factor (VEGF) via adenovirus-mediated gene transfer on survival of full thickness flaps selected randomly in rats.</p><p><b>METHODS</b>Thirty Sprague-Dawley rats weighing 480-520 g were used in this study. A dorsal flap (8 cm x 2 cm) in full thickness with the pedicle located at the level of the iliac crest was designed. Then the rats received 1,012 pfu replication-deficient recombinant adenovirus carrying VEGF (AdCMV-VEGF group, n=10), 1,012 pfu recombinant beta-galactosidase adenovirus (AdCMV-Gal group, n=10) and 1 ml saline (saline group, n=10), respectively, in the distal two thirds of the proposed flap by means of subdermal injection at 8 different locations. Three days after treatment, the flaps were elevated as originally designed and sutured back in situ. The survival rate of the flaps was evaluated on day 7 after operation.</p><p><b>RESULTS</b>The survival rate of the flaps in the AdCMV-VEGF group increased significantly as compared with those of the AdCMV-Gal group (P<0.01) and the saline group (P<0.01). Immunohistochemical staining showed that VEGF was expressed in the survival flaps injected with AdCMV-VEGF. Histological analysis showed that more granulation tissues and angiogenesis were observed in the AdCMV-VEGF group than those in the AdCMV-Gal and the saline groups.</p><p><b>CONCLUSIONS</b>Local application of adenovirus-mediated VEGF165 cDNA may efficiently improve the survival of ischemic skin flaps.</p>