Objective To expound the progress of the reparative and reconstructive surgery (RRS), especially in the recent 20 years, and the developmental direction in the future. Methods We reviewed the information from many books, journals, and conference compilations concerned with RRS. Results RRS emerged with modern surgery. After its development for 20 years, distinguished achievements were obtained in technologies, e.g., biological fixation of bone fracture, bioactive materials, stem cells, tissue engineering, bioactive factor, and induction/ derivation regeneration of tissues and organs. Moreover, ideas were continuously refreshed in RRS, such as emphasis on the equal importance of donor and recipient in autologous transplantation, and of structural and functional restoration in dentofacial surgery. Conclusion Further research programs should be conducted, especially in the fields of creative theories, innovative techniques, and rehabilitation engineering.
To investigate the operative method of repairing soft tissue defect of finger with modified reverse dorsal digital fascia flap and its cl inical effect of preventing and treating venous crisis. Methods From February 2005 to March 2007, 19 cases (22 fingers) with soft tissue defect of finger were treated, including 14 males (17 fingers) and 5 females (5 fingers) aged 2-62 years old (median 26 years old). There were 8 cases of cutting injury, 6 cases of crush injury, 4 cases of avulsion injury, and 1 case of hot crush injury, involving 3 thumbs, 7 index fingers, 6 middle fingers, 4 ring fingers and 2 l ittle fingers. The size of soft tissue defect was 1.5 cm × 0.8 cm-5.5 cm × 1.5 cm, and the time from injury to operation was 2-11 hours(average 7 hours). The axis of flaps was the l ine of transverse striation of fingers via dominant artery. The flaps were deflected dorsally, as “b” or “d”, to cover the wounds. Reverse dorsal digital fascia flaps 1.8 cm × 1.0 cm-6.0 cm × 2.0 cm in size were adopted to repair the defects. The donor site underwent skin grafting fixation. Results All flaps survived, without venous crisis and obvious swollen. The grafted skin in the donor site all survived. All patients were followed for 6-18 months (average 11 months). Postoperatively, color and texture of the grafted flaps were similar to that of normal skin, and the pulp of the fingers was normal. The two-point discrimination was 8-11 mm, and the activities of interphalangeal joint of all injured fingers were normal. Conclusion The modified reverse dorsal digital fascia flap is ideal for repairing soft tissues defects of the fingers, and can decrease the occurrence of venous crisis.
Objective To investigate the ability of the biodegradable polycaprolactone (PCL) material to repair bone defect and to evaluate the feasibility ofusing the PCL as the scaffold in tissue engineering bone. Methods The bone defect models of 4.5 mm×12 mm were made in the bilateral femoral condyle of 65 NewZealand white rabbits. The PCL cylinder was implanted into the right side of defect(experimental group, n=60), the high dense crystality hydroxyapatite was implanted into the left side of defect (control group, n=60), and the incision was sutured without any implants (blank group, n=5). The samples were harvested and observed by examinations of gross, X-ray, bone density,99mTc-MDP bone scanning, γ-display ratio and scanning electron microscope (SEM) after 3, 6, 9 and 12 months of operation. The results were compared between the experimental group and control group. Results At 3, 6, 9 and 12 months after operation, the gross and X-ray examinations indicated that the bone defect filled with the new bone onthe PCL-tissue surface, and no delayed inflammatory reaction appeared. The average bone mineral density was greater in the experimental group than that in the control group, and the difference had statistical significance(P＜0.05). Theresults of 99mTc-MDP bone scanning and γ-display ratio showed that thenuclide uptake was more in the PCL group than that in the control group. The SEM result proved that the new compact bone formed on the PCL migrating surface as the PCL degraded gradually，but the collagen fiber sheathe formed around the hydroxyapatitein the control group. Conclusion PCL possesses good biocompatibility and high bone inductive potentiality, it can be used to repair bone defect.
Objective To discuss the advantages and disadvantages of flaps in therepairment of soft tissue defects in upper extremity. Methods Based on the 2 609 cases of flaps in 2 512 patients from 1995 to 2004,the advantages and disadvantages of different sort of flaps, outcomes of treatment and indications of different soft of flaps were analyzed retrospectively. In the series, 2 089 pieces of the traditional flaps of different sorts were applied in 1 992 patients, 474 piecesof the axial flaps of different sorts were applied in 474 patients, different sorts of free flaps were used in 46 patients. Results Follow-ups were done for 1 month to 9 years (2.7 months in average). 2 531 flaps survived (97.01%); complete necrosis occurred in 10 flaps(0.38%); partial necrosis occurred in 68 flaps(2.61%). Of the 2 089 traditional flaps, 46 had partial necrosis(2.2%); 687 needed flap revisions(32.9%). Of the 474 axial flaps, 28 had complete or partial necrosis(5.9%); 82 needed revisions(17.3%). Of the 46 free flaps, 4 had complete or partial necrosis(8.7%) and nearly all the anterolateral flpas of thighs needed revisions.Conclusion Traditional flaps had the advantages of easy manipulation and the highest survival rate, however, also had the disadvantages of poor texture and many timesof operations. The flap with a pedicle had the advantage of good texture, consistent artery, free-range arc, however, the venous congestion was its disadvantage, which impaired the survival of the reverse flap. Free flap had the advantage ofgood texture and abandant donor site, but complicate manipulation was its shortage. Axial Flap with a pedicle is the optional choicefor repairing soft tissue defects in upper extremity.