Wedge-shaped excision and modified vertical mattress suture fully buried in a multilayered and tensioned wound closure.

BACKGROUND: A successful deep multilayered wound suture should provide a firm tension-relieving closure, good wound-edge eversion, hemostasis, and minimal intradermal extraneous materials. However, this is not always achieved with a single standard technique. The authors describe their modification of a wound closure method that can rapidly and reliably achieve these results. METHODS: A wedge-shaped excision was adopted to obtain a trapezoid pattern transect, after which a modified fully buried vertical mattress suture technique was used to close the wound. These techniques were compared with the standard excision and suture techniques used for the same patient at different times after surgery. RESULTS: The wedge-shaped excision can facilitate good wound-edge eversion, and the modified fully buried vertical mattress suture can provide firm tension relief and optimal apposition. Compared with conventional excision and suture techniques, the described techniques brought about a better outcome in terms of hypertrophic scar prevention. CONCLUSION: The described modified technique seems to be more efficient than conventional procedures used to prevent hypertrophic scar formation.

[The design of the expanded flap for the repair of the temporal and cheek area].

OBJECTIVE: To explore the design of an expanded flap at the temporal and cheek area. METHODS: The expanded flap was used for the repair of 619 temporal and cheek defects secondary to scar, nevus or hemangioma excision. In the frontal area, the rotational flap was usually used. For the repair of the cheek, the applied flap included the rotational, advanced, and transposition flap from the neck, as well as the pedicle flap from the thoracic area. RESULTS: Eight thoracic-deltoid flaps had distal necrosis of 1 approximately 5 cm. Of them, 5 flaps were repositioned with subsequent good result; the other 3 flaps underwent skin grafting. The five facial expanded flaps showed distal necrosis of 0.5 approximately 1 cm. Of them, 4 flaps occurred delayed healing, 1 flap underwent skin grafting. Expander extrusion happened in 41 cases (6.62%), which resulted in deficiency of the expanded area. Satisfactory results were achieved in all the other cases. CONCLUSIONS: According to our experience, careful design of the flap is very important for obtainingbetter surgical results and decreasing complications.

[Management of severe postburn scar contracture in the lower extremities].

OBJECTIVE: To summarize the clinical experience in the management of severe postburn scar contracture in the lower extremities. METHODS: The scars in popliteal fossa and ankle joint were excised. Traction and skin grafting were employed in the management of contracture deformity in these areas. RESULTS: Severe postburn scar contracture deformity in sixty postburn patients could be corrected by constant traction and skin grafting. CONCLUSION: Scar excision and lysis with constant traction might be an optimal method in the management of severe postburn scar contracture deformity of joints in the lower extremities and satisfactory results could be obtained without tendon grafting and elongation.

[Experimental study of tissue engineered blood vessel with vascular endothelial cell and vascular smooth muscle cell].

OBJECTIVE: To investigate the feasibility to seed vascular endothelial cell(VEC) and vascular smooth muscle cell (VSMC) into tissue engineered blood vessel scaffold material. METHODS: 1. A blood vessel scaffold with a combined polymer was designed, which mainly is composed of rabbit VSMC and collagen with reinforcement by a non-spinning fabric mesh made of polyglycolic acid (PGA). 2. VEC were isolated from rabbit thoracic aorta by enzyme digestion methods and subcultured and purified. Then the cells were seeded into scaffold material. The morphological characteristics of tissue engineered blood vessel was analyzed by scanning electron microscopy. RESULTS: VEC could adhere well to the inner surface of the tissue engineered tubular scaffold material with a tenacity and elasticity. VSMC could sustain bioactivity of cell. CONCLUSION: Non-spinning PGA porous biodegradable materials coated with collagen is benefit for cells to adhere and grow. It will lay a foundation of a laminated structure of tissue engineered blood vessel.

[Fabrication of a blood vessel scaffold with a combined polymer for tissue engineering].

OBJECTIVE: To investigate the possibility to fabricate a blood vessel scaffold with a combined polymer for tissue engineering. METHODS: A blood vessel scaffold was designed with a combined polymer composed of rabbit vascular smooth muscle cells(VSMCs), collagen and a non-spinning fabric mesh of polyglycolic acid (PGA). VSMCs were implanted into collagen gel and their growth was observed. The mixed solution of VSMCs and collagen was dropped into the tubular scaffold, followed by 7-day culturing. RESULTS: VSMCs formed many prominences after culturing in gelatinous collagen for 3-4 hours. With cells extending, some cells became shuttle- or spindle-shaped. After VSMCs-collagen complex was implanted into the PGA mesh, most of VSMCs remained in the pore of PGA mesh with the formation of gelation. VSMCs could adhere to and grow on the PGA fiber. CONCLUSION: The non-spinning PGA porous biodegradable material coated with collagen is a good carrier for VSMCs to adhere and grow.

[Preparation of compound biodegradable matrices and growth of vascular endothelial cell on them].

OBJECTIVE: To prepare the compound biodegradable matrices, polyglycolic acid (PGA), polylactic acid (PLA) mesh and poly-beta-hydroxybutyrate(PHB) which precoated with collagen, and to observe the growth and differentiation of bovine vascular endothelial cells on these scaffolds. METHODS: By enzymatic digestion methods, bovine vascular endothelial cell (VEC) were isolated from calf thoracic aorta, then cultured and purified. PGA, PLA, PHB meshes were dipped into cross-linked type I collagen solution, dried under vacuum frozen condition. VEC were seeded into these scaffolds. The growth of VEC on scaffolds was analyzed by MTT method. RESULTS: The collagen, PGA/collagen, PLA/collagen scaffolds were elasticity and tenacity. VEC grew better on collagen, PGA/collagen, and PLA/collagen membranes than on the PHB/collagen one. CONCLUSION: The PGA/collagen scaffold has elasticity, plasticity and tenacity. VEC grow best on it. It is an ideal scaffold for tissue engineered vessel reconstruction for it integrating both advantages of biomaterials and degradable materials.