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Limb replantation and transplantation is the optimal treatment for traumatic limb amputation. Safe and effective limb preservation is the key factor to determine the success of limb replantation and transplantation. Currently, static cold storage is the gold standard of limb preservation. However, the preservation time is short, which may no longer meet clinical requirements. With rapid development of organ preservation in recent years, novel preservation technologies, such as ultra-low temperature preservation, supercooling preservation and mechanical perfusion preservation, have successively emerged. However, at present, these techniques are primarily applied to the preservation of solid organs rather than composite tissue allografts with blood vessels including limbs. In this article, research status and progress on the application of static cold storage and mechanical perfusion preservation in limb preservation were reviewed, aiming to provide reference for clinical application of limb preservation technology and promote the development of limb replantation and transplantation.
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Objective:To explore the scanning and image reconstruction parameters, post-processing technology and effect of clinical application of Force CT microvascular anatomy imaging technology.Methods:From April 2019 to June 2021, 50 cases of free tissue flap transfer were reviewed in Department of Hand and Foot Surgery of Provincial Hospital Affiliated to Shandong First Medical University, including 34 males and 16 females in 3-67 (mean, 37) years old. In which, 33 cases were free flap, 10 were free composite tissue flap and 7 were digit reconstruction. CTA image score and clinical application evaluation were performed respectively. Follow-up was conducted by outpatient visit, telephone call and WeChat.Results:The qualified rate of Force CT microvascular anatomy imaging in 73 parts of 50 patients and the coincidence rate with clinical practice were 100%. All tissue flaps and reconstructed digits survived completely. No vascular compromise and other complicatiors occurred. The postoperative follow-up was 3 to 15 months, with an average of 11 months, and the flap healed well. Of the 7 reconstructed digits, 6 were satisfactory in appearance and 1 was reconstructed with flap plasty because of digit bloat.Conclusion:Force CT microvascular anatomical imaging technology can accurately display and reconstruct microvessels, and has guiding significance for the design and transfer of free tissue flap, which has a good promotion value.
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Objective:To explore the clinical effect of a two-staged repair and reconstruction of composite soft tissue defect of dorsal wrist with transfer of free flap (in stage-one) repair and followed by transplantation of allogeneic tendon (in stage-two) reconstruction.Methods:From December 2018 to January 2021, 6 cases with dorsal wrist composite tissue injury and extensor tendon defect were treated in the Department of Hand and Microsurgery of the Fourth People's Hospital of Guiyang City. Four cases were treated with free anterolateral thigh flap (ALTF) combined with allogeneic tendon in the first stage to reconstruct finger dorsiflexion function, and 2 cases were treated with free ilioinguinal flap combined with allogeneic tendon in the second stage to reconstruct finger dorsiflexion function. The age of the patients ranged from 22 to 62 years old. The areas of defect were 5.0 cm×12.0 cm-8.0 cm×20.0 cm. Two cases had 2 extensor tendons defect, 1 had 3 extensor tendons defect, 2 had 4 extensor tendons defect, and 1 had 5 extensor tendons defect. The length of extensor tendon defects was 7.0-22.0 cm. In 5 cases, the wounds were covered by VSD for 5 to 7 days after complete emergenly debridement. Then, after the wounds had been cleared and clean, the wounds of 3 cases were covered with free ALTF, 2 with free ilioinguinal flap, and 1 with free ALTF after skin graft scar resection. At 3-4 months later, the extension function of digit was reconstructed with the transplantation of allogeneic tendons. Postoperative appearance of the flaps and functions of digits were observed at the outpatient clinics during the follow-up.Results:The postoperative follow-up lasted for 10 to 26 (15 in average) months. All 6 flaps surrived completely, and 1 case was further treated with flap thinning at 4 months after the second surgery. During the follow-up, all flaps healed well and were good in appearance and texture. Meanwhile, the donor areas were all healed well with no dysfunction nor sensory disorder. All the transplanted tendons were in good glide without adhesion. The active motion of metacarpophalangeal joints ranged from (10±10) ° to (80±10) °. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, at the final follow-up, 4 cases were excellent and 2 cases were good.Conclusion:It is safe and effective that using the two-staged procedure in repair of composite tissue defect of dorsal wrist with stage-one ALTF or ilioinguinal flap transfer combined with stage-two reconstruction with transplantation of allogeneic tendon. It can minimize the adhesion after tendon transplantation and donor site damage
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Objective:To explore a surgical technique and treatment outcomes of the segmentle bridging reconstruction for severed fingers with single segmentle defect by using the free second toe bone-joint composite tissue combined with the great toe flap.Methods:From June 2010 to September 2017, 5 patients suffered from severed segmental defect of finger were treated. According to the defects of bone-joints, blood vessels, nerves, tendons and other soft tissues, the reconstruction surgery was designed to create a Flow-through bridging composite flap pedicled with the first dorsal metatarsal artery or the plantar artery. The blood vessles carried by the pedicle were anastomosed with the vessels in the finger to restore the blood supply to the distal finger while having the defected finger segment reconstructed. A Flow-through bridging composite flap was created by taking the second toe bone-joint composite tissue combined with a C-shaped or half-moon shaped flap from the fibular side of the great toe. Skin graft, retrograde lateral tarsal flap or free perforator flaps were used in 3 cases to repair the donor sites of the great and second toes. Iliac strip was implanted in 2 cases for toe salvage. Kirschner wires were removed 4-6 weeks after surgery followed by functional exercise.Results:All of the 5 reconstructed distal segments of the fingers survived with the healing of fractures in 8-12 week after surgery. The postoperative follow-up lasted 6-36 months and all the patients had the follow-ups at the outpatient clinic. It was found that the maximum flexion of the reconstructed interphalangel joint was 60 degrees together with dorsiflezion. According to the evaluation standard of the reconstructed function for thumb and finger issued by the Hand Surgery Society of the Chinese Medical Association, 3 fingers were in excellent and 2 in good. No obviouse affect on walking was found in all the patients.Conclusion:The free second toe joint composite tissue together with the great toe flap can be used to bridge the single segmental defect of a finger. It restores the blood supply to as well as the appearance of the distal finger, helps the recovery of the reconstructed distal finger. It is an ideal technique in the treatment of a severed distal segment of the finger.
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Composite tissue allotransplantation (CTA) is a novel transplantation discipline to treat functional tissue or limb defects. Since a majority of CTA grafts were vascularized grafts, it is also known as vascularized composite allotransplantation (VCA). The grafts of CTA/VCA consist of two or more types of allogeneic skin, subcutaneous tissue, bone, muscle, nerve and vessel, etc. Most of CTA/VCA grafts contain skin tissues, which possess the highest antigenicity. Acute rejection after transplantation is the primary obstacle leading to CTA/VCA graft failure and primary graft dysfunction. Hence, histopathological characteristics of skin rejection in CTA/VCA grafts have become the primary hotspot. In this article, pathological features of CTA/VCA rejection, Banff classification in 2007 and related research progress were reviewed, aiming to provide reference for the diagnosis and treatment of rejection and other complications of CTA/VCA.
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Objective:To investigate the modified application of orbicularis oculi muscle-levator aponeurosis composite tissue flap fixation technique (modified Park method) in double-eyelid surgery.Methods:From June 2019 to March 2021, 823 patients included 92 males and 731 females, aged from 18 to 45 years with mean (31.4±7.9) years, in which 142 patients with slightly ptosis were selected to receive the treatment in the Department of Plastic Surgery of the Affiliated Hospital of Nangjing University of TCM. The symmetry of bilateral double eyelids after operation was evaluated by the third party. The marginal reflex distance (MRD1) was measured before and 6 months after operation, and the difference between preoperative and postoperative MRD1 (ΔMRD1) was calculated. And the postoperative complications were counted. The patients were followed up from 6 to 12 months after surgery to evaluate the long-term results.Results:The patients were followed up for 4-22 months (mean 10 months) after operation. And the incisions of all the 823 cases had primary healling. Most patients had smooth upper eyelid crease, upturned lashes and dynamic fold. The skin tended to spread evenly without dimple. The symmetry evaluation by the third party showed that there were 764 patients with symmetry and basic symmetry after operation, the symmetry rate was 92.8%; 59 patients with asymmetry, the asymmetry rate was 7.2%. The data of MRD1 increased significantly 6 months after operation, from (3.25±0.72) mm to (3.64±0.61) mm, and the ΔMRD1 was (0.38±0.76) mm ( t=-20.41, P<0.05). The difference between the two groups was statistically significant. The double eyelid line became shallow in 8 cases and disappeared completely in 3 cases. The double eyelid curve of the patients was natural and smooth after the operation. And there was no obvious sunken scar and pretarsal fullness. Conclusions:The " modified Park technique" blepharoplasty can obtain a more firm, symmetrical and natural appearance. And the mild ptosis could be corrected by this method. The anatomical structure can be identified clearly, and the surgical results are highly repeatable. It is worth promoting.
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BACKGROUND: Prefabricated composite tissue flaps have been used by Bakamjjan for cardiac repair since 1973, but have not been widely used due to technique limitations. Domestic research on prefabricated composite tissue flaps to repair limb bones is rarely reported. OBJECTIVE: To analyze the effects of prefabricated composite tissue flaps in the repair of limb bone and corresponding soft tissue defects. METHODS: New Zealand big rabbit models of bone fracture and soft tissue defect of the extremities were constructed (first operation) and randomly divided into three groups. In group A, prefabricated composite tissue flap was used to treat bone and soft tissue defects of the extremities at 10 days after modeling (second operation). In group B, free femur was used to treat bone and soft tissue defects of the extremities at 10 days after modeling. In group C, the incision was open and sutured with no treatment. General condition, body weight, imaging finding and histological findings were compared between groups. RESULTS AND CONCLUSION: There was 100% survival in all the three groups. Graft displacement was observed in 2 rabbits in the group B, but the deformity healed, which had little effect on the rabbit's mobility. The weight recovery and gain were higher in the group A than in the group B (P < 0.05). The imaging findings showed that a large number of calluses were formed in the group A at 2 weeks after operation, which were bridged in gap at 4 weeks after operation, filled in the defect gap at 8 weeks, and remodeled at 12 weeks. In the group B, a small amount of calluses were formed at 2 weeks after operation, and began to increase at 4 weeks. The femoral cut was obvious. A large number of calluses were formed at 8 weeks after operation, and the defect gap was filled at 12 weeks after operation. In the group C, the callus began to form at 8 weeks after operation, and the defect gap was still present, with osteosclerosis at the two ends. The Lane-Sandhu score was statistically different between the three groups at 8 and 12 weeks after second operation (P < 0.05). Histological observation indicated that a large number of newly formed osteoblasts and bone cells were formed in the group A at 4 weeks after operation, and the tubular structure increased and irregular bone island formed at 8 weeks; new bone formed at 12 weeks, with the presence of the medullary cavity containing yellow bone marrow dominated by adipocytes. In the group B, most of the grafted bones were degraded and absorbed at 4 weeks after operation, and osteoblasts were ossified at 8 weeks. The remaining implanted bones were still visible. Most of the osteoblasts were ossified and became lamellar bones at 12 weeks. In the group C, the defect area was filled with a large amount of fibrous connective tissues at 12 weeks after operation, and there was no bone formation. To conclude, the prefabricated composite tissue flap can be used to repair the bone and soft tissue defects of the extremities, and it has a faster and better therapeutic effect than the traditional free bone repair.
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Objective@#To report our clinical application of free fibular composite tissue flap with peroneus longus and brevis in the treatment of complicated extremity trauma.@*Methods@#From August 2014 to September 2017, 5 patients with complicated extremity trauma were treated using a free fibular composite tissue flap with peroneus longus and brevis at Department of Orthopaedics, The Sixth People's Hospital of Shanghai. They were 4 men and one woman, aged from 23 to 52 years (average, 35.1 years). All of them had tendon defects; one had a radius defect, one an ulnar defect and three a tibial defect. The length of bone defects ranged from 8 cm to 18 cm; the size of soft tissue defects ranged from 10 cm × 5 cm to 18 cm ×8 cm. A fibular composite tissue flap was designed according to the soft tissue condition and defect area to repair and fixate the bone defect after thorough debridement and cover the wound before functional reconstruction. Postoperatively, survival of the flap and functional recovery of the corresponding tendon at the recipient site, healing time of the tibia, and wound healing, ankle motion and complications at the donor site were all observed.@*Results@#The 5 patients were followed up for 18 to 38 months (average, 25.2 months). All flaps survived without any vascular crisis or infection. The union time for the fibular graft ranged from 4 to 16 months (average, 8.4 months). In the 3 patients with a tibial defect, the maximum angle of dorsal extension ranged from 0° to 10° and no foot drop was observed. Thumb and digital flexion was reconstructed in the patients with a forearm bone defect only to achieve opposition of index finger and thumb but we failed to make them have a fist. At the 5 flap donor sites, the wound was sutured by the second stage after vacuum suction and healed well; obvious scar formed in one of them. No obvious foot varus was observed at the donor site. The patients were satisfactory with their ankle joint motion. No refracture of the fibular graft occurred during follow-up.@*Conclusion@#A free fibular composite tissue flap with peroneus longus and brevis is a good choice for complicated extremity trauma.
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Objective To report our clinical application of free fibular composite tissue flap with peroneus longus and brevis in the treatment of complicated extremity trauma.Methods From August 2014 to September 2017,5 patients with complicated extremity trauma were treated using a free fibular composite tissue flap with peroneus longus and brevis at Department of Orthopaedics,The Sixth People's Hospital of Shanghai.They were 4 men and one woman,aged from 23 to 52 years (average,35.1 years).All of them had tendon defects;one had a radius defect,one an ulnar defect and three a tibial defect.The length of bone defects ranged from 8 cm to 18 cm;the size of soft tissue defects ranged from 10 cm × 5 cm to 18 cm × 8 cm.A fibular composite tissue flap was designed according to the soft tissue condition and defect area to repair and fixate the bone defect after thorough debridement and cover the wound before functional reconstruction.Postoperatively,survival of the flap and functional recovery of the corresponding tendon at the recipient site,healing time of the tibia,and wound healing,ankle motion and complications at the donor site were all observed.Results The 5 patients were followed up for 18 to 38 months (average,25.2 months).All flaps survived without any vascular crisis or infection.The union time for the fibular graft ranged from 4 to 16 months (average,8.4 months).In the 3 patients with a tibial defect,the maximum angle of dorsal extension ranged from 0° to 10° and no foot drop was observed.Thumb and digital flexion was reconstructed in the patients with a forearm bone defect only to achieve opposition of index finger and thumb but we failed to make them have a fist.At the 5 flap donor sites,the wound was sutured by the second stage after vacuum suction and healed well;obvious scar formed in one of them.No obvious foot varus was observed at the donor site.The patients were satisfactory with their ankle joint motion.No refracture of the fibular graft occurred during follow-up.Conclusion A free fibular composite tissue flap with peroneus longus and brevis is a good choice for complicated extremity trauma.
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Objective: To investigate the clinical application and effectiveness of the composite tissue flaps pedicled with perforating branch of posterior tibial artery for repairing distal leg defects. Methods: Between September 2014 and August 2017, 12 patients with skin and bone defects of distal leg were repaired with the composite tissue flaps pedicled with perforating branch of posterior tibial artery. There were 8 males and 4 females with an average age of 41.3 years (range, 25-66 years). The causes of injury included traffic accident injury in 7 cases, heavy crushing injury in 2 cases, tibial osteomyelitis with soft tissue ulcer and necrosis in 2 cases, and bone and soft tissue defect after resection of bone tumor in 1 case. Eight patients underwent primary repair, and 4 patients underwent second-stage repair. The size ranged from 6 cm×4 cm to 10 cm×7 cm in skin flap, from 4.0 cm×2.5 cm to 8.0 cm×6.0 cm in muscle flap, and from 4 cm×2 cm×2 cm to 5 cm×4 cm×4 cm in tibial bone flap. Tibial defects of the donor region were repaired by autologous iliac bone grafting, and the wounds were sutured directly in 7 cases and repaired by autologous skin grafting in 5 cases. Results: All composite tissue flaps survived and both the recipient and the donor wounds healed primarily. All patients were followed up 6-12 months, with an average of 10.8 months. The appearance, color, texture of the composite tissue flaps and ankle function were satisfactory. X-ray films showed that the bone flap at the tibia defect and the ilium graft at the donor site both healed well at 6 months after operation. Conclusion: The composite tissue flaps pedicled with perforating branch of posterior tibial artery has abundant blood, and it is a good donor region for repairing the distal leg defects combined with circumscribed bone defect.
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Objective To explore the clinical application and effect of free fibula composite tissue flap trans鄄plantation to repair bone and soft tissue defect after open fracture of proximal tibial. Methods From June, 2012 to June, 2018, free fibula composite tissue flap transplantations were applied to repair bone and soft tissue defect after open fracture of proximal tibial in 11 cases.Of the 11 cases, there were 10 males and 1 female(their ages ranged from 32 to 56, 36 on average); Six cases were caused by traffic accident, and 5 by crash. There were 3 fresh wounds and 8 chronic and infective wounds. Free fibular flaps were used in 7 cases, and free fibular flexor hallucis myocutaneous flaps were used in 4 cases.The fibular length with transplantation was 7-18 cm.The area of flaps or muscle flaps was ranged from 4 cm×8 cm to 8 cm×20 cm. Bone fracture healing was observed at 3, 6 and 12 months after operation. The function of injured extremity was evaluated in 1 year after surgical operation. Results All were successfully repaired, and composite tissue flaps survived. Of which, 10 wounds healed by first intention, and 1 wound healed by secondary intention, with the healing time of 12-18 days.All 11 cases were followed-up.The mean followed-up time was 18 months. The bone healing time ranged from 6 to 9 months (7 months on average). The Enneking Score System was applied to evaluate the leg function. Of the 11 cases, the mean scores was 25 (ranged from 22 to 27). The donor sites were not found malfunctional. Conclusion Transplantation of free fibula composite tissue flap can reduce the treatment time with good mechanical strength. It is an ideal method to repair bone and soft tissue defect after open fracture of proximal tibial.
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Objective@#To explore the clinical application and effect of free fibula composite tissue flap trans-plantation to repair bone and soft tissue defect after open fracture of proximal tibial.@*Methods@#From June, 2012 to June, 2018, free fibula composite tissue flap transplantations were applied to repair bone and soft tissue defect after open fracture of proximal tibial in 11 cases. Of the 11 cases, there were 10 males and 1 female(their ages ranged from 32 to 56, 36 on average); Six cases were caused by traffic accident, and 5 by crash. There were 3 fresh wounds and 8 chronic and infective wounds. Free fibular flaps were used in 7 cases, and free fibular flexor hallucis myocutaneous flaps were used in 4 cases. The fibular length with transplantation was 7-18 cm. The area of flaps or muscle flaps was ranged from 4 cm×8 cm to 8 cm×20 cm. Bone fracture healing was observed at 3, 6 and 12 months after operation. The function of injured extremity was evaluated in 1 year after surgical operation.@*Results@#All were successfully repaired, and composite tissue flaps survived. Of which, 10 wounds healed by first intention, and 1 wound healed by secondary intention, with the healing time of 12-18 days. All 11 cases were followed-up. The mean followed-up time was 18 months. The bone healing time ranged from 6 to 9 months (7 months on average). The Enneking Score System was applied to evaluate the leg function. Of the 11 cases, the mean scores was 25 (ranged from 22 to 27). The donor sites were not found malfunctional.@*Conclusion@#Transplantation of free fibula composite tissue flap can reduce the treatment time with good mechanical strength. It is an ideal method to repair bone and soft tissue defect after open fracture of proximal tibial.
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Resumen Introducción. La inducción de tolerancia inmunológica solucionaría los problemas asociados con la inmunosupresión de por vida, necesaria para evitar el rechazo de aloinjertos. Objetivos. Revisar aspectos inmunológicos, modelos clínicos utilizados y resultados obtenidos en la tolerancia y comparar los resultados obtenidos con trasplante de órgano sólido y alotrasplante compuesto vascularizado. Materiales y métodos. Se realizó una búsqueda en la base de datos PubMed que arrojó 299 resultados; se revisaron las bibliografías de los artículos y se consultaron las referencias pertinentes. Al final se seleccionaron 83 artículos. Resultados. Existen mecanismos centrales y periféricos para mantener la tolerancia a antígenos propios; en la práctica clínica, la tolerancia central ha sido más utilizada, esto se ha hecho mediante estrategias que utilizan trasplante conjunto de medula ósea. Varios ensayos clínicos, la mayoría en pacientes con trasplante renal, han mostrado resultados prometedores pero inconsistentes. Conclusiones. En trasplantes renales fue posible suspender de forma exitosa la inmunosupresión, mientras que en trasplantes de mano se logró disminuirla considerablemente. El quimerismo inmunológico parece ser indispensable para el desarrollo de tolerancia a aloinjertos, por lo que es necesario desarrollar protocolos para inducir quimerismo mixto persistente.
Abstract Introduction: Immune tolerance induction could solve problems associated with lifelong immunosuppression, necessary to avoid allograft rejection. Objectives: To review immunological aspects, clinical models used and results achieved and to compare the results with solid organ transplantation and vascularized composite allotransplants. Materials and methods: A literature review was made in the PubMed database, yielding 299 results. The bibliography of the articles was reviewed and the pertinent documents were consulted. Finally, 83 articles were selected. Results: There are central and peripheral mechanisms to maintain tolerance to self-produced antigens. In clinical practice, central tolerance has been widely used through strategies that involve bone marrow transplantation. Several clinical trials, mostly in kidney transplant patients, have shown promising but inconsistent results. Conclusions: Immunosuppression was successfully suspended in renal transplantation patients, while its use was reduced considerably in hand transplantation patients. Immunological chimerism seems to be essential to develop tolerance to allografts, so it is necessary to elaborate protocols to induce persistent mixed chimerism.
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Objective To introduce a breast conserving surgery for reconstruction of breast shape and to demonstrate the postoperative effect.Methods Ten patients were treated with this method from Apr.2016 to Dec.2017,and the lateral thoracic wall arteriovenous vessels were used as vascular pedicle to transfer the distal compound tissue flap of the blood vessel to repair the breast defect remnant cavity which was formed after the breast conserving surgery,and a good shape was obtained.Results All the 10 cases were successfully completed.The intraoperative bleeding was 20 to 30 ml.The operative time was 2 to 3 hours.No blood transfusion was needed.The average hospital stay was 11.5 days,ranging from 10 to 15 days.No infection happened to the incision.All the 10 patients were followed up from 2 to 20 months,with 11 months as the average.No limb edema,asymmetry or local recurrence happened.Conclusion The operation method is effective,safe and economical for patients with large swelling but strong desire to conserve breast.
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Abstract Introduction: Hand transplantation was first reported in 1964, and is currently one of the challenges that the 21st century poses to Medicine. Several related studies and advances have been achieved, thus allowing to explore new alternatives for patient management. Many reference centers have performed their own analyzes based on their experience, which has led to increase the viability of this type of transplant. Objective: This review seeks to provide an overview of hand transplantation and to propose a management algorithm. Materials and methods: Several criteria must be met to select candidates, including clinical, paraclinical and psychosocial assessment performed by a multidisciplinary team. Immunosuppression seeks to avoid rejection, while immunosuppressants must have appropriate serum levels to reduce adverse effects. Classical and atypical acute rejection cases have been reported, where the skin is the main target tissue. Chronic rejection cases are related to the blood vessels that become affected. Monitoring is performed using several tests, considering skin biopsy as the gold standard. Results: Drug therapy complications derive from drug toxicity, which are manifested as metabolic disorders, development of opportunistic infections and neoplasms. Rehabilitation and social aspects, such as patient satisfaction, should be evaluated during recovery to ensure adherence to immunosuppressive therapy. In 2011, the international registry of hand and composite tissue transplantation reported 39 cases of upper limb transplantation with multiple results. All this proves that to achieve optimal and viable results, a multidisciplinary team must conduct proper follow-up, and that the patient should have a support and motivation network, and comply with pharmacological management. Conclusion: Further research is expected to create strategies to develop tolerance and, thus, reduce management by immunosuppression.
Resumen Introducción. El trasplante de mano ha sido uno de los retos del siglo XXI, cuyo primer caso reportado ocurrió en 1964. En este campo se han hecho estudios y avances que permitieron explorar nuevas alternativas para el manejo del paciente con trasplante de mano, por lo que diversos centros de referencia han realizado análisis basados en sus experiencias, las cuales permitieron lograr la viabilidad de este tipo de trasplante. Objetivo. Esta revisión busca dar una visión general sobre el trasplante de mano y proponer un algoritmo de manejo. Materiales y métodos. La selección de candidatos requiere una serie de criterios, tales como evaluación clínica, paraclínica y psicosocial, desarrollados por un equipo multidisciplinario. La inmunosupresión busca evitar el rechazo y los inmunosupresores deben tener los niveles séricos apropiados para reducir sus efectos adversos. Se han reportado casos de rechazo agudo clásico y atípico, donde la piel es el principal tejido blanco, y rechazo crónico, en el cual se afectan los vasos sanguíneos. El seguimiento se realiza con varias pruebas, de modo que la de oro es la biopsia de piel. Resultados. Las complicaciones del tratamiento farmacológico derivan de la toxicidad de los medicamentos y se manifiestan como alteraciones metabólicas, infecciones oportunistas y neoplasias. La rehabilitación y los aspectos sociales, como el grado de satisfacción del paciente, deben ser evaluados durante la recuperación para asegurar adherencia al tratamiento. En 2011 el registro internacional de alotransplante compuesto de mano reportó 39 casos de trasplante de extremidades superiores con resultados variables; todo esto evidencia que para lograr un resultado óptimo y viable del trasplante debe realizarse seguimiento por un equipo multidisciplinario, red de apoyo del paciente y motivación del mismo, junto con el cumplimiento del manejo farmacológico. Conclusión. Se espera que nuevas investigaciones puedan crear estrategias para desarrollar tolerancia y, de esta forma, reducir el manejo mediante inmunosupresión.
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Methods@#To explore the transplantation of flow-through anterolateral thigh flap combined with fibular flap for reconstruction of composite tissue defect at leg.@*Method@#12 cases with leg composite tissue defects were reconstructed by flow-through anterolateral thigh flaps combined with fibular flaps. The skin defects ranged from 6 cm×12 cm to 12 cm×20 cm. The bone defects were 4-10 cm in length.The size of flow-through anterolateral thigh flaps was 14 cm×8 cm to 23 cm×13 cm and the fibular osteocutaneous flaps were 6 cm×4 cm to 12 cm×6 cm. The fibular bone was harvested as 7 cm to 13 cm in length.@*Results@#All the flaps survived in 12 cases. Bony reunion was achieved in all the cases. Vascular crisis happened in 2 cases 1 day after operation. Margin necrosis occurred in distal end of one flap, which healed after dressing. All the flaps had soft texture with satisfactory cosmetic and functional result . There was no complication in donor sites.@*Conclusions@#Flow-through anterolateral thigh flap combined with fibular flap can reconstruct soft tissue defect and bone defect simultaneously. It is the ideal method for leg composite tissue defects.
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Objective To explore the surgical technique of applying the pedicle composite tissue flap based on superficial palmar branch of the radial artery to repair the soft tissue defect of thumb and evaluate the clinical ef-fect. Methods From February,2013 to March, 2016, 5 cases of the soft tissue and tendon defect of thumb were treated with the pedicle composite tissue flap based on superficial palmar branch of the radial artery. The flap was de-signed at wrist not exceeding the wrist rasceta and the donor site was sutured directly. The size of the harvested flaps was between 3.0 cm ×2.2 cm to 4.2 cm ×3.2 cm, and the sensation of thumb or the flap was reconstructed via median nerve cutaneous branch. The Extensor pollicislongus muscle tendon defect was repaired via palm tendon carried by composite tissue flap. Postoperative follow-up was done termly. Results All transfering flaps survived and all cases were followed-up for 4 to 11 months. The donor site got primary healing with a linear scar. The appearance and tex-ture of the flap was satisfactory. The two-point discrimination ranged from 8 to 11 mm. The appearance of thumb re-covered well and the digit joint had a good motion. Conclusion The pedicle composite tissue flap based on superfi-cial palmar branch of the radial artery is easy to harvest and its vascular anatomy is constant, which is masked and a small incision for the donor site. When necessary, palm tendon or median nerve cutaneous branch can be contained in the flap to form a composite transplant. It is an ideal method for repair of thumb soft tissue defect.
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Objective To investigate the clinical efficacy of using the tissue engineering bone loaded with adipose derived stem cells (ADSCs)and perforator flap in the treatment of composite tissue defects.Methods From April,2013 to June,2015,there were 9 cases of traumatic bone and skin composite tissue defects,including 7 males and 2 females,with an averaged age of 43 years old.The ADSCs were isolated,induced and co-cultured with demineralized bone scaffold.The tissue engineering bone and deep inferior epigastric artery perforator (DIEP) flap were adopted for reconstruction of composite tissue defects.Results All 9 patients were followed up for 12-36 months,averaged of 18 months.The bone growth was obviously for 5 cases with bone defects at the middle and lower part of the tibia.They tolerated full weight bearing walking.One case of middle humeral bone defect demonstrated normal bone tissue growth,and the 2/3 of cross section had been restored.One case of humeral bone defect and 1 case of radial bone defect reached bone union.The remaining 1 with skull defect showed new bone growth,but it had not yet achieved complete bone healing.Conclusion The combination of tissue engineering bone and perforator flap is a minimally invasive,easy accessible and effective method for reconstruction of composite tissue defects.
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Objective To determine the outcome of the combined use of flaps transfer and ilizarov technique reconstruct the large soft tissue defects and bone lose in the lower leg.Methods Sixteen patients were identified from a retrospective review from July,2008 to July,2013,who suffered the large soft tissue defects and bone lose in the lower leg and underwent single-stage soft tissue and osseous reconstruction using the flap technique and Ilizarov method.There were 12 males and 4 females aged from 22 to 62 years old (average 42.6 years old).The size of soft tissue defect ranged from 8 cm×9 cm to 30 cm×20 cm.The length of the bone discrepancy ranged from 2 to 14 cm.According to the local condition of the lower leg and the size of the composite tissue defects,10 patients received the free flap covering,6 patients repaired by the saphenous neurocutaneous perforator flap (3 cases) and sural nerve neurocutaneous flap (3 cases).Daily monitoring the skin temperature postoperative.Distraction was commenced on postoperative day 10 to 14 at the rate of 1 mm/day and continued in 4 equal increments.Results The follow-up time ranged from 18 to 36 months.Sixteen flaps survived completed,only 1 flap was observed the venous congestion in postoperative day 2.The duration of ilizarov application ranged from 3.5 to 18.0 months.All patients achieved final union.All patients were satisfied with the outcome of the surgery.Conclusion The combined use of neurocutaneous flap and Ilizarov technique for reconstruction of large composite soft tissue defect in the lower leg.Significantly reduce patient treatment time,improving traction osteogenesis of long bones and the ability of resistance to infection.
RESUMO
El quiste óseo simple es una patología pseudotumoral características de las dos primeras décadas de la vida, localizada principalmente en húmero o fémur. La localización metatarsiana es considerada rara. El peroné puede ser utilizado para reconstrucción de defectos óseos. Se realizó estudio observacional, descriptivo, en el Hospital Dr. Adolfo Pons de Maracaibo, Edo Zulia, Venezuela, donde presentamos paciente femenino de 12 años de edad, en quien se reconstruyó defecto óseo metatarsiano producto de resección de quiste simple, mediante injerto no vascularizado de peroné. Se obtuvo consolidación e integración total de injerto con resultado funcional excelente(AU)
Simple bone cyst is a pseudotumoral condition that when coming up, it usually occurs during the first two decades of life, mainly located in the humerus or femur. The metatarsal location is considered rare. The fibula can be used for bone defects reconstruction. An observational and descriptive study was conducted at Dr. Adolfo Pons Hospital, in which we present a 12 years old patient who underwent a second metatarsal bone defect reconstruction with a non-vascularized fibular graft after resection of a simple cyst. Graft consolidation and total integration were obtained with excellent functional outcome(AU)