Free anterolateral thigh flap for coverage of scalp large defects in pediatric burn population.

Free anterolateral thigh flap is considered by most surgeons to be the proper choice for restoring scalp defect in the adult population. However, in the pediatric burn population with scalp large defects, the use of this flap has not been well described. From December 2005 to June 2009, 11 free anterolateral thigh flaps were performed to cover scalp defects in eight male children and three female children aged between 3.1 and 5.9 years (mean age: 5.0 years). Causes for the lesions include boiling liquid (5 cases), frictional heat (4 cases), and electricity (2 cases). Defect sites include parietal region (6 cases), occipital region (3 cases), temporal region (1 cases), and forehead (1 case). The size of the flaps ranged from 10 to 25 cm in length and from 8 to 18 cm in width. All the patients were followed up from 5.0 months to 2.1 years after the operation. Satisfactory contour results were shown. The overall flap success rate was 100%. There were no complications such as infections or hematomas after surgery. All the donor sites were covered with no morbidity observed. The free anterolateral thigh flap provides immediate vascularized coverage in scalp large defect that were unable to be treated by other methods, such as local flap or tissue expansion. Despite the smaller diameter of the vessels in pediatric population than that in adults, it is conceivable that this flap should be the reasonable and reliable method of large scalp defect coverage in pediatric population.

[Preparation of polyvinyl alcohol/chitosan hybrid nanofibrous scaffolds and study on its biodegradation behaviors in vivo and in vitro].

OBJECTIVE: To fabricate polyvinyl alcohol (PVA)/chitosan hybrid nanofibrous scaffolds owning the similar physiological structure of ECM, and to observe its biodegradation behavior in vivo and in vitro. METHODS: (1) The PVA nanofibrous scaffold and PVA/chitosan hybrid nanofibrous scaffold were fabricated by electrospinning technique, and then they were crosslinked by glutaraldehyde vapor method. The morphology of both scaffolds was observed by scanning electron microscope (SEM). (2) Biodegradation experiment in vitro: the samples of two scaffolds with size of 2 cm x 2 cm were placed into phosphate-buffer saline (PBS) fluid under 37.0 degrees C water for incubation, and then they were dried to observe morphologic changes under SEM on post incubation day (PID) 3, 7, and 14. (3) Biodegradation experiment in vivo: 48 Wistar rats were divided into PVA group and PVA/chitosan group according to the random number table, with 24 rats in each group. PVA or PVA/chitosan nanofibrous scaffold was implanted into subcutaneous tissue on both sides of back in rats of both groups, with 4 scaffolds in each rat. The scaffold samples were harvested to observe morphologic changes with HE staining on post operation day (POD) 3, 7, 14, and 28. RESULTS: (1) After crosslinking, the surface of fibers in PVA and PVA/chitosan hybrid nanofibrous scaffolds were smooth, and the diameters of fibers were similar, ranging from 200 to 300 nm, with high porosity. (2) Biodegradation experiment in vitro showed that the morphologic changes in fiber was respectively swelling, dissolution, fusion in PVA nanofibrous scaffold on PID 3, 7, 14, and that in PVA/chitosan hybrid nanofibrous scaffold was respectively swelling, dissolution and fragmentation, and disappearance. (3) Biodegradation experiment in vivo showed that the morphologic changes in scaffold structure was respectively loosening, fuzziness of edges, degradation, and disappearance in PVA group and PVA/chitosan group on POD 3, 7, 14, 28. CONCLUSIONS: PVA/chitosan hybrid nanofibrous scaffolds can be prepared with electrospinning technique, and it has an appropriate biodegradation rate compatible with tissue reconstruction after crosslinking.

Surgical treatment of brachial plexus carcinoma metastasized from non-ipsilateral breast cancer.

Lesions of the brachial plexus may arise for various reasons. Metastatic carcinoma involving the non-ipsilateral brachial plexus is a relatively rare condition. This report presents the case of a 56-year-old woman with brachial plexus carcinoma metastasized from non-ipsilateral breast cancer. After admission, minute examinations were arranged, which gave support to the previous diagnosis. Extended resection of the tumor mass in- and outside the foramen was performed. One month after the operation, the sensation of the left upper extremity began to recover gradually. Due to multi-organ failure, she died 2 months post-surgery. This case underscores the need for appropriate diagnosis of brachial plexus abnormalities. In addition to the common causes, it should be noted that brachial plexus abnormalities could even occur on the contralateral side.