We determined superoxide radical in ischemia-reperfu-sion to skin flaps by electron spin resonance and observed itseffect to skin flap survival. The experimental results showthat superoxide radical arise in ischemia-reperfusion. By per-fusion with superoxide dismutase,as free radical scavengers,significantly improved flap survival rate over controls. Basedon experimental date, the pathology mechanisms of skin flapnecrosis is discussed.
Objective To introduce the application of the scrotal flap on reconstructing partial urethra defect. Methods From March 1998 to August 2004, 31 patients with urethra defect were treated with scrotal flap. Their ages ranged from6 to 34 years. Thirty-one patients included 8 cases of congenital deformity of urethra and 23 cases of complication of urethral fistula, urethral stenosis and phallus bend after hypospadias repair. The flap widths were 1. 2. cm in child and 2.3. cm in adult. The flap lengthwas 1. -2.0 times as much as the width. Nine cases were classified as penile type, 10 cases as penoscrotal type, 7 cases as scrotal type(3 children in association withcleft scrotum) and -cases as perrineal type because of pseudohermaphroditism.Urethroplasty was given by scrotal fascia vascular net flap to reconstruct urethra defect. Results All the flaps survived, and the incision healed well. Twenty four cases achieved healing by first intention and 7 cases by second intention. And fistula occurred and healed after 2 weeks in 1 case. 27 cases were followed up 14 years, 2 cases had slight chordee, the others were satisfactivly. Conclusion Urethroplasty with scrotal fascia vascular net flap is an ideal method for the partial defect urethra.
OBJECTIVE: To evaluate clinical result of reconstructed thumb and finger with a free hallux nail flap(HNF) and frozen-phalanx-joint-tendon-sheath composite tissue allograft in 270 cases. METHODS: The patients were followed up with reexamination in the ambulant clinic, communication, X-ray photography, lab-examination, isotope 99mTc MDP and reoperation. The data were analyzed by statistics or proved by clinical observation, which were followed up for five years in average (ranging from five months to sixteen years). RESULTS: Enveloping the allogeneic finger composite tissue with self-HNF and pieces of phalanx of great toe, it could reconstruct a thumb or finger with good contour and nutrition. The excellent rate of opposition function of the reconstructed thumbs was 71.91%. The sense of the fingers recovered after 3 months to 8 months of operation. Two-point discrimination was 3 mm to 15 mm. The junction between implanted allo-phalanges and auto-phalanges could be hastened by implanted with vascularized autogenous phalanx pieces in the HNF. The isotope 99mTc MDP was used to take X-ray photography in 24 cases for four months to 9 years and seven months, which showed that the blood vessels grew into the allo-phalanges. However, the Charcot’s arthropathy of allogeneic joints and bony absorption still could be seen in some cases. That might be concerned with chronic abrasion of joint or chronic rejection of host to graft. CONCLUSION: The operation is fit for repairing the defect of thumb or finger in any degree. The implanted vascularized self-phalanx pieces can promote bone union, but it can not prevent the allogeneic joints from arthropathy or bone absorption
Objective To investigate the anatomic foundation of using main branch of posterior femoral nerve to restore the sensation function of distal basedsural island flap. Methods Thirty cases of adult human cadaver legs fixed by 4%formaldehyde were used. Anatomical investigation of the posterior femoral nerves of lower legs was conducted under surgical microscope to observe their distribution, branches and their relationship with small saphenous vein. Nerve brancheswith diameter more than 0.1 mm were dissected and accounted during observation.The length and diameter of the nerves were measured. Results The main branch of posterior femoral nerve ran downwards from popliteal fossa within superficial fascia along with small saphenous vein. 70% of the main branch of the posterior femoral nerves lay medially to small saphenous vein, and 30% laterally. They wereclassified into 3 types according to their distribution in lower legs: typeⅠ (33.3%) innervated the upper 1/4 region of lower leg (region Ⅰ), type Ⅱ (43.3%) had branches in upper 1/2 region (region Ⅰ and Ⅱ), and type Ⅲ (23.3%) distributed over the upper 3/4 region (region Ⅰ, Ⅱ and Ⅲ). In type Ⅱ, the diameter of the main branches of posterior femoral nerves in the middle of popliteal tossa was 10±04 mm and innervated the posterior upper-middle region (which was the ordirary donor region of distal based sural island flaps) of lower legs with 2.0±0.8 branches, whose diameter was 0.3±0.2 mm and length was 3.5±2.7 mm. The distance between the end of these branches and small saphenous vein was 0.8±0.6 mm. In type Ⅲ, their diameter was 1.2±0.3 mm and innervated the posterior upper-middle region of lower legs with 3.7±1.7 branches, whose diameter was 0.4±0.1 mm and length was 3.7±2.6 mm. The distancebetween the end of these branches and small saphenous vein was 0.8±0.4 mm. Conclusion 66.6% of human main branch of posteriorfemoral nerves (type Ⅱ and type Ⅲ) can be used to restore the sensation of distal based sural island flap through anastomosis with sensor nerve stump of footduring operation.
Objective To explore the results of repairing widespread traumatic soft tissue defects in the heels and adjacent regions with free latissimus dorsi muscle-skin flaps. Methods From March 1998 to May 2005, 10 cases of widespread traumatic soft tissue defects in the heels and adjacent regions were repaired with free latissimus dorsi muscleskin flaps. Of the 10 patients, 9 were male and 1 was female, whose ages ranged from 32 to 60years, and the disease course was 2 hours to 2 months. The defect was by ploughmachine injury in 5 cases, by crush injury in 2 cases, by snake injury in 2 cases, and electricity injury in 1 case. Eight cases of defects involved in the posteriorof heel and leg, the defect area ranged from 21 cm×12 cm to 35 cm×15 cm; 2 cases had widespread soft tissue defects on heel, ankle, sole and dorsal foot, and the defect area was 27 cm×14 cm and 30 cm×21 cm respectively. All cases were accompanied by the exposure of bone; 6 cases by fracture; 4 cases by openinfection of ankle joint; and 2 cases by injuries of the posterior tibial vessel and the tibial nerve. The sizes of the dissected flap ranged from 25 cm×14 cm to 33 cm×24 cm. The donor sites were covered by large mid-thickness flap. Results There were no postoperative complication of vascular crisis and infection. Ten flaps survived completely and the wounds healed by first intention. After a follow-up of 3 to 24 months, five cases received twostageplastic operation because bulky flaps bring some trouble in wearing shoes. In 5cases of reconstructed sensation, two cases recovered pain and temperature sensation. All cases recovered the abilities to stand and walk without ulcer complication. Conclusion The free latissimus dorsi muscle-skin flap is an ideal flap for repairing widespread traumatic soft tissue defects and infectious wounds with muscle defects and bone exposure in the heel and adjacent regions, because it has such advantages as adequate blood supply, big dermatomic area, and excellent ability to resist infection.
From 1984 to 1993, 49 cases with varioussoft tissue defects around the knee were treated with pedicled calf myocutaneous flap, lateral sural cutaneous artery island skin flap, saphenous neurovascularskin flap and fasciocutaneous flap. The postoperation results were sucessful in 47 cases, and failure 2 cases, in one case with flap infection and theother with scar formation surrounding the knee. Both the failure cases were cured with split skin graft. The patient were followed up for an average of three and a halfyears, the knee function was almost completely regained, and the blood supply of the flaps, the elasticity and colour of the flaps were similiar to that of the normal skin, without being cumbersome. The sensation of the saphenous neurovascular flaps and the lateral suralcutaneous artery island flaps was preserved, except partial numbness was presented at the distal part of the flaps. Operative indications and selection of cases were discussed.
Objective To determine whether the different durations and times of the ischemic preconditioning affect the effectiveness of the ischemic preconditioning. Methods Ninety male Wistar rats were randomly divided into the control group and the eight preconditioned groups of 10 rats each. A transverse rectus abdominis musculocutaneous flap (TRAM) was elevated in each rat. The flaps were preconditioned by clamping the pedicle and reperfusing for 5 or 10 minutes per cycle. This was repeated for one or two cycles. The controls were simply perfused for 30 minutes. Each flap was then subjected to 4 hours of the global ischemia. Three rats in each group were killed for anestimate of the water content in the muscle and for observation on the muscularstructure under microscope. The flap surface survival areas of the other rats were calculated on the 7th postoperative day by the computerized video planimetry. Results The water content in the muscle was evidently reduced. The mean survival area of the flap in every preconditioned group increased by2-3 times compared with that of the controls(P＜0.001). The different proceduresof the ischemic preconditioning produced different protective effects. Conclusion The ischemic preconditioning is an available means to alleviate an ischemiareperfusion injury to the transverse rectus abdominis musculocutaneous flap in rats. The effect of the ischemic preconditioning is affected by the duration and time of the ischemic preconditioning.
Objective To investigate the effect of the vascular endothelial growth factor (VEGF) gene therapy, the surgical delay, and the combination of the two therapeutic approaches on the survival of the rat over-area abdominal axial skin flap. Methods In 48 male Wistar rats (weight, 400-450 g), a model of the abdominal axial skin flap supplied by the superficial epigastric blood vessel was created. The rats were randomly divided into 6 groups: Group A (the blank group), Group B (the gene-therapy-during-operation group), Group C (the gene-therapy-before-operation group), Group D (themerely-surgical-delay group), Group E (the gene-therapy-during-surgical-delay group), and Group F (the gene-therapy-aftersurgical-delay group). Seven days after operation, the survival rate of the skin flap was measured; the specimens were harvested from the skin flap for a histological investigation of themicrovessels and for an immunohistochemical staining to observe the expression of VEGF165. Results The average survival rate of the skinflap was significantly greater in each of the treated groups than in Group A (Plt;0.05); the rate was the greater in Group E (Plt;0.05), but with no statistically significant difference between the other treated groups (Pgt;0.05). The average number of the microvessels was significantly greater in Groups B, C, E andF than in Groups A and D (Plt;0.05), but with no statistically significant difference between Groups B, C, E and F and between Groups A and D (Pgt;0.05). The lumen diameter of the microvessels was significantly greater in Group D than in Groups E and F (Plt;0.05), and the diameter was significantly greater in Groups D, E andF than in the other groups (Plt;0.05). More deposition of VEGF DNA detected by the immunohistochemical staining was in Groups B, C, E and F than in Groups A and D. There was no newly-formed blood vessel in the rat cornea in the treated groups.Conclusion Both the administration of pcDNA4-VEGF165 and the surgical delay can improve the survival of the rat abdominal axial skin flap, but the mechanism of the effect is different in explanation. The combination of the two therapeutic approaches can achieve a better effect.
OBJECTIVE: To evaluate the clinical efficacy of fasciocutaneous flap in the repair of the III degree burn wound in the facio-cervical region. METHODS: From January 1997 to October 2001, 11 cases of III degree burn wounds in the facio-cervical region were repaired with the cervical-thoracic fasciocutaneous flap ranging from 18 cm x 8 cm to 13 cm x 5 cm. Donor sites were covered with "Z" plasty or skin grafting. RESULTS: Except for partial necrosis of distal end of the flap in 1 case, the flaps in the other 10 cases all survived and presented satisfactory appearance and function during the following up. CONCLUSION: The fasciocutaneous flap in the cervical-thoracic region may provide a large area of flap, and can be easily transferred. It’s an ideal flap for the repair of skin defect in the facio-cervical region, especially for the repair of the wounds with infection or exposure of vessel, nerve and tendon.