Large heel soft tissue defects managed successfully with reverse medial crural fasciocutaneous flap: a 7-year single-center experience with 21 consecutive cases.

The medial crural fasciocutaneous flap is a reliable cutaneous flap that can be used for soft tissue reconstruction in the extremities. The purpose of this article is to evaluate the application and clinical significance of this surgical technique in the reconstruction of heel soft tissue defects. Twenty-one cases of heel soft tissue defect between March 2005 and March 2012 were included in this study. Wound sizes varied from 5.0 × 5.5 to 7.5 × 10.0 cm. All cases were managed with a reverse medial crural fasciocutaneous flap. Patient demographics and case information were analyzed and are reported. The sizes of the reverse medial crural fasciocutaneous flap varied from 6.5 × 10.0 to 9.0 × 15.0 cm; the average size was 7.7 × 13.8 cm. Out of the 21 consecutive cases, 20 flaps survived intact and one flap underwent partial necrosis. Follow-up observations were conducted for 6-36 months. The cosmetic results were satisfactory, without apparent bulkiness; the weight-bearing outcomes were satisfactory. The donor site can be closed primarily or by skin graft. Reverse medial crural fasciocutaneous flap transfer is appropriate for the reconstruction of heel soft tissue defects. The method is safe and can cover large heel defects.

Burns induced by cupping therapy in a burn center in northeast china.

UNLABELLED: Cupping therapy as a curative skill has been developed and applied throughout history. Despite reports of adverse effects, this therapy is considered to be relatively safe with no systemic reviews documenting negative side effects. The aim of this study was to explore methods that avoid the adverse effects sometimes associated with this therapy. METHODS: Clinical records of 14 outpatients and inpatients that visited the First Hospital of Jilin University (Changchun, China) for management of burn injuries caused by cupping therapy were retrospectively reviewed. Characteristics, history of injury, and treatment of each patient was collected and analyzed. RESULTS: Burn injury induced by cupping therapy was not uncommon. Most of the injuries were mild to moderate and cured by conservative methods without severe complications. The use of wet cupping was more prevalent among injured patients than dry cupping. CONCLUSION: Cupping therapy as an ancient alternative treatment is still popular with a large number of devoted practitioners. Although there is the potential for injury during the application of this therapy, this is mostly preventable. Standardized training for health care professionals and increased the awareness among the public about the proper methods to administer this therapy to avoid adverse effects is important.

The coverage of skin defects over the foot and ankle using the distally based sural neurocutaneous flaps: experience of 21 cases.

Skin defects over the foot and ankle remain a challenge to plastic surgeons. The distally based sural neurocutaneous flap is a reliable and effective procedure. The authors have performed 21 cases (22 flaps) since 2000. Twenty-one flaps survived uneventfully. The recipient range included the dorsum of the foot, heel and forefoot. The texture, thickness and colour were satisfactory although pressure ulcers occurred on flaps over the weight-bearing region, such as sole. The factors that influence the survival of the flap are the width of the pedicle, ligation of the lesser saphenous vein and complete vascular network around the ankle.

Reimplantation combined with transplantation of transgenic neural stem cells for treatment of brachial plexus root avulsion / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore a new method to treat brachial plexus root avulsion experimentally by reimplantation combined with transplantation of neural stem cells (NSCs) modified by neurotrophin-3 gene (NT-3).</p><p><b>METHODS</b>The total RNA was extracted from neonatal rat striatum and the NT-3 cDNA was obtained by reverse transcription and amplified by polymerase chain reaction. The NT-3 gene was transferred into NSCs via the pLEGFP-C1, an expression plasmid vectors. The untransfected NSCs, the pLEGFP-C1 treated NSCs, and the pLEGFP-C1-NT-3 treated NSCs were transplanted into corresponding spinal cord segment with brachial plexus root avulsion. The survival, differentiation, and migration of the transplanted cells were determined under confocal laser scanning microscope or by immunohistochemistry method. The nerve regeneration was evaluated by gross observation, electrophysiological examination and reverse horseradish peroxidase tracing.</p><p><b>RESULTS</b>The NT-3 gene was successfully amplified and transferred into neural stem cells via the plasmid vectors. The transplanted cells survived, differentiated, and migrated and NT-3 was expressed within the spinal cord. The animals regained some muscle strength which was less than 3-degree muscular strength according to the British Medical Research Council (BMRC) evaluating system. The results of electrophysiological examination and reverse horseradish peroxidase tracing were superior in the pLEGFP-C1-NT-3 group to the NSCs untransfected group or the pLEGFP-C1 group.</p><p><b>CONCLUSION</b>Transplantation of NSCs modified by NT-3 gene combined with reimplantation is a relatively effective way to treat brachial plexus root avulsion experimentally. It still need further study to improve the results.</p>

Free fillet foot flap for salvage of below-knee amputation stump / 中华创伤杂志(英文版)

Management of extensive bone and soft tissue defects, which occur after severe trauma of lower extremities and always lead to an unacceptable amputation in some cases, continues to challenge reconstructive surgeons. When performing lower extremity amputation, preservation of the knee joint has been put into a higher priority. The benefit of below-knee amputation over above-knee ones concentrates on a more normal gait with less energy expenditure during ambulation when a functioning knee joint is present.

Coverage of skin defects in spaghetti wrist trauma: application of the reverse posterior interosseous flap and its anatomy.

BACKGROUND: To introduce the application of reverse posterior interosseous flap in spaghetti wrist trauma. METHODS: From 2003 to July 2005, 12 cases of skin defects over the volar wrist in spaghetti wrist trauma were covered by the reverse posterior interosseous flap. The size of the skin defects ranged from 5 cm x 4 cm to approximately 10 cm x 6 cm when the wrist was in the neutral position. The skin defects over donors were covered by split skin graft. RESULTS: All flaps and skin grafts survived uneventfully. The follow-up period was at least 3 months. The texture, color, and thickness of the skin paddle matched the surrounding skin. The sensation of the flap recovered to S0 to S1 on a five-point scale. The functional recovery of the hand and fingers was dependent on the original injuries to the tendons and nerves. CONCLUSION: The reverse posterior interosseous flap is a suitable alternative to cover skin defects in spaghetti wrist. The pedicle should include 2 cm of fascia and septum between the extensor carpi ulnaris and extensor digiti quinti proprius, and the subcutaneous tunnel should be wide enough to avoid venous congestion. Temporarily blocking the proximal end of the posterior interosseous artery to observe the blood supply of the flap is helpful to avoid its failure before completing the flap.

The reverse dorsal metacarpal flap: experience with 153 cases.

The authors have performed reverse dorsal metacarpal flaps in 153 cases to cover skin defects over fingers or stumps during the past 15 years. Its indications included acute and chronic skin defects over the second to fifth fingers or stumps. The coverage of the flap ranged from the base of the fingers to the distal interphalangeal joint. One hundred forty-three cases survived uneventfully, and 8 cases presented venous congestion postoperatively, which led to epidermal necrosis. The reverse dorsal metacarpal flap is a reliable and excellent method to cover skin defects over the fingers.

Retrospective study of reverse dorsal metacarpal flap and compound flap: a review of 122 cases / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the clinical application and discuss the operative indication of the reverse dorsal metacarpal flap and its compound flap on the skin defects of hand.</p><p><b>METHODS</b>From 1990 to 2003, we applied the reverse dorsal metacarpal flap and its compound flap to repair soft tissue defects of fingers in 122 cases, which included 90 cases of the reverse metacarpal flap and 32 cases of its compound flaps with tendon grafts, nerve grafts or bone grafts. Based on the follow-up observations, we analyzed the indications of the reverse metacarpal flap and its compound flaps, the postoperative contours, flap colors and textures in comparison to contralateral fingers retrospectively.</p><p><b>RESULTS</b>In the series of 122 cases, flaps survived and the donor site defects were closed directly. The follow-up period ranged from 1-12 years. The postoperative contours, colors and textures of the flaps and its compound flaps were similar to those of normal fingers, although linear scar remained. According to standards of sense recovery (British Medical Research Council, BMRC), the sense function of the flaps resumed S3 after operation for 1 year. In 10 cases with the tendon defects treated by the flap with tendon grafts, function of flexion-extension of fingers resumed 50%-75% in comparison to the contralateral fingers using the method of measurement of total active motion. In 7 cases with the phalangeal nonunion or bone defects treated by the flap with bone grafts, union occurred after operation for 3 months.</p><p><b>CONCLUSIONS</b>To soft tissue defects on fingers with bone or tendon exposure, the reverse metacarpal flap and its compound flap are a better choice for repairing. The range of repairing is up to the distal interphalangeal joint of fingers. The second dorsal metacarpal artery is more consistent and larger as the choice of vascular pedicle, in comparison with other dorsal metacarpal arteries. Postoperative flap color and texture are similar to normal fingers.</p>

Biological effect of velvet antler polypeptides on neural stem cells from embryonic rat brain / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Velvet antler polypeptides (VAPs), which are derived from the antler velvets, have been reported to maintain survival and promote growth and differentiation of neural cells and, especially the development of neural tissues. This study was designed to explore the influence of VAPs on neural stem cells in vitro derived from embryonic rat brain.</p><p><b>METHODS</b>Neural stem cells derived from E12-14 rat brain were isolated, cultured, and expanded for 7 days until neural stem cell aggregations and neurospheres were generated. The neurospheres were cultured under the condition of different concentration of VAPs followed by immunocytochemistry to detect the differentiation of neural stem cells.</p><p><b>RESULTS</b>VAPs could remarkably promote differentiation of neural stem cells and most neural stem cells were induced to differentiate towards the direction of neurons under certain concentration of VAPs.</p><p><b>CONCLUSION</b>Neural stem cells can be successfully induced into neurons by VAPs in vitro, which could provide a basis for regeneration of the nervous system.</p>

The experimental study on effect of the spinal neuron flow with the nerve repair time / 中华显微外科杂志

Objective To measure Ihe effect on rats spinal neuron flow according nerve roots repair time.Methods We adopted the experimental rats on the root avulsion and extravertebral foramen nerve root divison of C_(5～7).We divided them into four groupsin each which there were 16 ratsaccording the type of nerves root injury and repair timeGroup AC:the avulsed roots were reimplanted into the spinal cord and the transeeted roots were sutured to the proximal stump immediately.Group B,Dthe avulsed roots and the transected roots were reimplanted into the spinal cord or were sutured to the proximal stump in delayed 3 weeks each with 16 rats.At the different time point(3 weeks3 months6 months)through pathological examina- tion and immunohistological lechniques and nerve tracing techniqueswe examined the spinal cord and distal nerve trunk in order to observe the pathologic changes and axonal regeneration.Results Group A、C were much better than group B、D in the numberthe conformation and the degree of abatement of spinal motoneu- rons and nissl body.It is the same on the number and the development level of regenerating nerve fiber. Conclusion It had the advantage of neuronal protection and nerve regeneration that reparing the injured nerve roots earlv after nerve roots injury.