Polyfoliate anterolateral thigh perforator flap in reconstruction of large soft tissue defects around ankle: a study on 11 cases / 中华显微外科杂志

Objective:To evaluate the viability and clinical effect of polyfoliate anterolateral thigh perforator flap (ALTPF) in reconstruction of large soft tissue defect around ankle.Methods:From June 2019 to October 2022, large soft tissue defects around ankle of 11 patients were reconstructed with ALTPF in the Department of Orthopaedics of the First Affiliated Hospital of Nanchang University. The causes of injury were traffic accident in 8 patients and heavy objects in 3 patients. All wounds were large defects (15.0 cm×14.0 cm-30.0 cm×20.0 cm) and combined with various degrees of infection. Intraoperatively, polyfoliate ALTPFs sized 16.0 cm×14.5 cm-23.0 cm×18.5 cm were used in reconstruction of the defects. Deep dead spaces were filled with antibiotic bone cement, and direct suture was performed to close the donor sites or by skin grafting repair. Postoperative follow-ups were scheduled at 1, 3 and 6 months, and 6 monthly thereafter at outpatient clinics and via telephone interviews. The appearance and colour of the flaps and healing of donor sites were recorded together with evaluation of the recovery of ankle motor function according to the ankle-hindfoot rating scale of American Orthopaedic Foot and Ankle Society (AOFAS).Results:All flaps survived. No haematoma or secondary infection occurred at the recipient site after surgery. All donor sites healed primarily. One patient had venous occlusion at the distal end of the polyfoliate ALTPF. The flap survived completely at 1 week after distal venous bloodletting. Postoperative follow-ups lasted 6-24 (15.27±5.21) months. All flaps had good blood supply with satisfactory appearance, similar colour and texture to the recipient sites, and without obvious bloat nor ulceration. Only a linear scar or few skin graft scar was left at the flap donor sites in concealed locations. The mean AOFAS ankle-hindfoot score was (88.36±10.21) point. There were 6 cases of excellent, 4 cases of good, and 1 case of fair.Conclusion:A polyfoliate ALTPF is an ideal flap for reconstruction of soft tissue defects around ankle by converting the length of a flap to the width.

Flaps transfer with allogeneic tendon transplantation in reconstruction of composite defect of Achilles tendon and surrounding soft tissue / 中华显微外科杂志

Objective:To investigate the clinical efficacy in one stage reconstruction of composite defects of Achilles tendon and surrounding soft tissues with a flap transfer combined with allogeneic tendon transplantation.Methods:From July 2018 to August 2022, a total of 12 patients, including 9 males and 3 females, with a mean age of 31.5(ranged 8 to 56) years old, had surgery with flap transfer combined with transplantation of allogeneic tendon in one stage reconstruction for compound defects of Achilles tendon and soft tissue at the Department of Orthopaedics of First Affiliated Hospital of Nanchang University. The defects of Achilles tendons ranged from 4.0 to 9.0 cm, and the soft tissue defects sized from 3.0 cm × 4.0 cm to 14.0 cm × 6.0 cm. Of the 12 patients, 6 received transfers of sural neurovascular flaps, 3 with peroneal perforator flaps and 3 with free anterolateral thigh flaps(ALTF). The flaps sized from 4.0 cm × 4.5 cm to 15.0 cm×7.0 cm, and in addition, allogeneic tendon grafts were used to reconstruct the defects of Achilles tendons in all patients. All the flap donor sites were either directly sutured or covered with skin grafts. Follow-up was carried out by visits of outpatient clinic or telephone or WeChat distant interviews. The flap survival and recovery of ankle function and Achilles tendon were observed.Results:During the 3 months to 2 years of follow-up, none of the patient showed obvious immunological rejection against the transplanted allogeneic tendon. All 12 flaps survived well with the colour and texture close to the surrounding skin. No ulceration occurred in both of the donor and recipient sites. There was no re-rupture of the transplanted allogeneic tendon. At the final follow-up, ankle movement was measured at 13.4°±2.6° in dorsal extension and 33.6°±3.2° in plantar flexion. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hind foot function score, a score of 88.7±5.6 was achieved with 7 patients in excellent, 4 in good and 1 was acceptable.Conclusion:In patients with a composite defect of Achilles tendon and surrrounding soft tissue, the application of a flap transfer combined with a homogeneous allograft tendon transplantation in an one stage surgery is a feasible surgical procedure. It can achieve a satisfactory outcome with less trauma and fewer complications.

Anterolateral thigh flaps for reconstruction of soft tissue defect in lower extremities caused by the Gustilo Ⅲopen fracture / 中华显微外科杂志

Objective To evaluate the effectiveness of free anterolateral thigh flaps for the reconstruction of lower extremities vast soft tissue defect caused by Gustilo Ⅲ open fracture. Methods From June,2013 to December, 2016,pedicled vascular anterolateral thigh flaps with end-to-side vascular anastomosis were adopted to repair 10 cas-es of lower legs caused by Gustilo Ⅲ open fracture and soft tissue defects. Among those cases,6 cases combined with anterior tibial arteries injury and 4 cases with posterior tibial arteries injury. The receiving arteries were anastomosed with flaps arteries in end-to-side method and the receiving veins were anastomosed in end-to-end method. All pa-tients were regular follow-up, and follow-up contents included flap appearance, color, limb ischemia. Results All the flaps survived in10 cases. Venous crisis was happened in one case,and flap survived after the exploration. Two cases delayed healing because of wound infection.All the 10 cases were followed up for 3-24 months,with an average of 10 months.The skin flaps of 10 cases were thin and well fitted,with good appearance and soft texture. The color of the flaps were similar to that of the recipient areas.The appearance and function of the affected limbs were satisfacto-ry. Conclusion Free anterolateral thigh flap with end-to-side vascular anastomosis is an ideal method to repair the vast soft tissue defects caused by Gustilo Ⅲ open fracture.

The peroneal artery perforator flap for the reconstruction of serious heel spoke injuries in children / 中华显微外科杂志

Objective To explore the clinical effect of peroneal artery perforator flap for the treatment of serious heel spoke injuries in children.Methods From July,2014 to September,2017,13 children with severe heel and ankle injuries were treated by peroneal artery perforator flap.There were 9 males and 4 females,with an average age of 6.5 years (ranged from 3 to 11 years).The size of flaps ranged from 10.0 cm×3.0 cm to 14.5 cm×5.0 cm.The donor sites were sutured directly or covered with skin grafting.Regular follow-up was performed to observe the survival status of the flap and the functional recovery of the ankle joint.Results Twelve flaps survived completely.One flap had partial marginal necrosis in the distal portion,which was healed after dressing.Partial inadequate venous return happened in 1 case,which also recovered by the removal of part of the suture.All cases were followed-up for 3 months to 20 months.The appearance,texture,and color of the flaps were similar to the surrounding skin.No ulcer occurred.All case acquired normal gait.Conclusion The peroneal artery perforator flap is a good option for reconstruction of serious heel spoke injuries in children.The flap has consistent blood supply while leaving minimal morbidity at donor site.

Treatment of scaphoid nonunion fractures by vascularized radial periosteum graft from the dorsal distal radius / 中华骨科杂志

Objective To investigate the clinical effects of scaphoid nonunion fractures by vascularized bone graft which can reconstruct fracture blood circulation. Methods From March 2013 to December 2014, 28 cases of patients with scaphoid fractures and nonunions were studied, including 16 males and 12 females whose age arranged from 19 to 33 years with a mean age of 26.2 years, for whom waist fractures and nonunions accounted 25 cases, and proximal end of scaphoid accounted 3 cases. The patients received treatments, vascularized radial periosteum graft was transversely implanted after radial periosteal flap pedicled on their current branch of the radial artery between the first and second tendinous sheath had been separated. Then 15 cases were fixed by Kirschner wire and 13 by Herbert screw. X?ray films were taken and checked regularly and periodically at 1th, 2nd, 3rd, 6th, 12th month after the operation to follow up fracture union and wrist function rehabilitation. Results All 28 cases of patients were followed up after operation for a period ranging from 5 to 12 months (with an average of 8 months). All patients with scaphoid fractures and nonunions were cured. The fractures and nonunions were clinically healed within 3 to 5 months and the patients didn't suffer from wrist pain basically. The wrist functions of those patients were evaluated according to modified Mayo wrist score:21 were rated as excellent, 5 as fine, 2 as fair, the excellent and good rate was 93%(26/28). The excellent and good rate of Kirsch?ner wire group was 93%(14/15), and the Herbert screw group was 92%(12/13). The difference in the excellent and good rate was not statistically significant between Kirschner wire group and Herbert screw group (χ2=0.011, P=0.916). Conclusion Fixed with Kirschner wire or Herbert screw, using vascularized radial periosteum graft to treat scaphoid fractures and nonunions has good short?term clinical effects. The operation manner with simple operation is an effective treatment, which can improve the blood sup?ply of the scaphoid fracture.

Effect of tetrandrine on the TGF-ß-induced smad signal transduction pathway in human hypertrophic scar fibroblasts in vitro.

PURPOSE: To evaluate in vitro effects of tetrandrine on the TGF-ß-induced smad signal transduction pathway and cellular function altered by tetrandrine in human hypertrophic scar fibroblasts (HSFs). METHODS: HSFs were exposed to four different treatments (control, tetrandrine, TGF-ß(1) and mixture). After 48 h culture, expression of TGF-ß1, Smad2 and Smad7 were examined using reverse transcription PCR and Western blotting. To evaluate cellular function alteration, morphological changes of HSFs were observed under an inverted microscope, expression of type I and III collagen were tested by immunocytochemistry, and cell cycles were analyzed by flow cytometry. RESULTS: Expression of Smad7 increased while expression of Smad2 and TGF-ß1 mRNA decreased in HSFs with tetrandrine. In addition, type I and III collagen was suppressed and S phase of the cell cycle markedly shortened in HSFs by tetrandrine. CONCLUSIONS: These results suggest that tetrandrine inhibits HSFs at least partially through induction of Smad7 and decrement of Smad2 resulting in inhibition of TGF-ß1 transcription and its intracellular signaling, which led to reduction of type I and III collagen production and suppression of cell reproductive activity.

Proliferation changes of human epidermal stem cells in response to transfection with human telomerase reverse transcriptase gene / 中华创伤杂志

Objective To investigate the changes of human epidermal stem cells after transfected with human telomerase reverse transcriptase(hTERT)gene.Methods The plasmid pIRES2-EGFP and plasmid pIRES2-EGFP-hTERT encoding hTERT were transfected into in vitro cultured human fetal epidermal stem cells by liposome-mediated transfection.Then,the positive cells were selected with G418.The mRNA and protein expressions of hTERT were detected by reserve transcriptase-polymerase chain reaction(RT-PCR)and Western blot.The telomerase activity and the proliferation and cycle of human epidermal stem cells were detected by telomeric repeat amplification protocol(TRAP)-ELISA and flow cytometry respectively.Results RT-PCR and Western blot techniques detected weak mRNA and protein expressions of hTERT gene in untransfected and vacant vector transfected cells but high level of mRNA and protein expressions of hTERT gene in pIRES2-EGFP-hTERT transfected cells.Compared with untransfected and vacant vector transfected cells,the pIRES2-EGFP-hTERT transfected cells had higher telomerase activity,with lower proportion of cells at G_0/G_1 phase,higher proportion of cells at S and G_2/M phases and enhanced proliferation ability.Conclusion Transfection with hTERT gene can markedly enhance mRNA and protein expressions,telomerase activity and proliferation ability of hTERT gene of human epidermal stem cells euhured in vitro.

Effective research about local oxygen therapy to promoting renovation of residual surface of burns wound / 中国实用护理杂志

Objective In order to know the effective of local oxygen therapy to promoting renovation of residual surface of bums wound.Methods Divided 60 patients with burns into the experimental group and the control group,there were 30 cases in the each group.Routine nursing cares were used in the control group,while the local oxygen therapy was used in the experimental group.Compare the condition of secretion of wound between the two groups.Results The wound healing time of experimental grou was(5.87±3.29)d,which significant shorten than that of in the control group,the kinds of bacteria in the control group was more than in the experimental group.Conclusions The local oxygen therapy can effective promote the healing of residual surface of bums wound,which can reduce the infection rate of bacteria.