Objective To review the research progress of composite tissue allotransplantation (CTA), analyzethe superiority and the inferiority, and inform the possible direction of further research. Methods Literature concerningCTA was reviewed and analyzed in terms of the l imits of conventional reparative and reconstructive surgery, the definitionof CTA, potential advantages, and treatment risks. Results The cl inical research of CTA both at home and abroad proved that the therapeutic effect of CTA was better than that of conventional reparative and reconstructive surgery. However, therisks resulting from immunosuppressive therapy were still the primary factors restraining the wide cl inical appl ication ofCTA. Conclusion The development of immunosuppressive therapy explores a great development potential for the CTA, and how to decrease the treatment risk of immunosuppressive therapy will be the main research direction in the field of CTA.
Objective To summarize the clinical effects of the repairing methods for deep wounds of the foot and ankle. Methods From March 2002 to June 2006, 49 patients with skin and deep tissue defects of the foot and ankle underwent the repairing treatment. Of them, 36 were males and 13 were females, aged 16 to 67 years( 39 years on average). The causes of injuries included mangled injury in 24 cases, high fall injury in 9 cases, cut injury in 7 cases, malignant soft tissue tumor in 5 cases, decubital ulcer in 2 cases, and electric burn in 2 cases. Of the 49 cases, 19 were in left side and 30 in right side. The defect size of skin ranged from 3 cm×2 cm to 20 cm×15 cm and deep tissue injuries were accompanied by defects of tendon and ligament in 24 cases, by damage of joint in 12 cases, and by bone defect in 9 cases, and 35 of them had infections, and 2 of them had diabetes of stage 2. The time between the injury and surgery ranged from 4 hours to 1 year.The wounds were repaired separately by local flap(3 cm×3 cm to 6 cm×4 cm) in 15 cases, local island flap(8 cm×5 cm to 12 cm×7 cm) in 25 cases, free flap(15 cm×11 cm to 24 cm×17 cm) in 4 cases, and cross leg flap(5 cm×4 cm to 8 cm×6 cm) in 5 cases. In 24 cases of defects of tendon and ligament, 15 underwent the reconstruction in one-stage operations,9 in two-satge operation.In 9 cases accompanied by bone defect, twostage bone grafting (12-64 g) was given after wound healed. Results All of the 49 flaps survived. Fortysix healed by the first intention and 3 with distal edge necrosis healed after skin grafting. Two patients with sinus formation healed after 68 months of dressing change. All the cases were followed up 6 months to 3 years, and all the flaps were well developed, the functions of the foot and ankle were satisfactory. Conclusion It can get an excellent result of appearance and function recovery repairing deep wounds of the foot and ankle with proper flaps in earlier time.
To provide anatomical evidences for the blood supply compound flap based on fibular head to rebuild internal malleolus. Methods The morphology of vessels and bones in donor site and in recipient site was observed. The materials for the study were l isted as follows: ① Forty desiccative adult tibias (20 left and 20 right respectively) were used to measure the basilar width, middle thickness, anterior length, posterior length and introversion angle of internal malleolus; ② Forty desiccative adult fibulas (20 left and 20 right respectively) were used to measure the middle width and thickness, as well as the extraversion angle of articular surface of fibular head; ③ Thirty adult lower l imb specimens which perfused with red rubber were used to observe the blood supply relationships between the anterior tibial recurrent vessels and fibular head, and internal anterior malleolar vessels inside recipient site. Results The internal malleolus had a basilar width of (2.6 ± 0.2) cm, a middle thickness of (1.3 ± 0.2) cm, an anterior length of (1.4 ± 1.9) cm and a posterior length of (0.6 ± 0.1) cm. Its articular facet was half-moon. Its introversion angle was (11.89 ± 3.60)°. The fibular head had a middle thickness of (1.8 ± 0.6) cm, a middle width of (2.7 ± 0.4) cm. Its articular facet was toroid, superficial and cavate in shape, and exposed inwardsly and upwardsly, and had a extraversion angel of (39.2 ± 1.3)°. The anterior tibial recurrent artery directly began from anterior tibial artery, accounting for 93.3%. Its initiation point was (4.5 ± 0.7) cm inferior to apex of fibular head. Its main trunk ran through the deep surface of anterior tibial muscle, and ran forwards, outwards and upwards with sticking to the lateral surface of proximal tibia. Its main trunk had a length of (0.5 ±0.2) cm and a outer diameter of (2.0 ± 0.4) mm. Its accompanying veins, which had outer diameters of (2.1 ± 0.5) mm and (2.6 ± 0.4) mm, entry into anterior tibial vein. It constantly gave 1-2 fibular head branches which had a outer diameter of (1.7 ± 1.3) mm at (1.0 ± 0.4) cm from the initiation point. The internal anterior malleolar artery which began from anterior tibial artery or dorsal pedal artery had a outer diameter of (1.6 ± 0.4) mm. Its accompanying veins had outer diameters of (1.3 ± 0.5) mm and (1.1 ± 0.4) mm. Conclusion The blood supply compound flap based on fibular head had a possibil ity to rebuild internal malleolus. Its articular facet was characterized as the important anatomical basis to rebuild internal malleolus.
Objective To review the information of platelet gel used in the basic and clinical research in reparative and reconstructive surgery.Methods Literature about platelet gel used on the basic and clinical research was obtained through searching medical data and Internet. The effect of platelet gel on repairing and reconstructing the function and structure of tissue and organ was analyzed. Results Platelet gel had many growth factors and had the ability to improve wound healing and regenesis of bone and other tissues. Conclusion Platelet gel is widely available and almost genuine and is able to improve regenesis of many kinds of tissues. Extensive and intensive research should be made on itsclinical application.
Objective To study diagnosis, treatment and rebuilding of scrotum gangrene. Methods From January 1992 to September 2004, 15 patients with scrotum gangrene were treated and their clinical data were analysed.Their ages ranged from 23 to80 years. The results of bacterial culture were positive for wound sample in 14 cases and for blood in 1 case. All the patients underwent surgical treatment including incision,aggressive debridement,drainage,irrigation and antibiotic therapy. Two patients accepted hyperbaric oxygen therapy. All the patients received scrotum rebuilding by transfer of skin flap, skin grafting and suturation and orchectomy was given in 2 elder patients. Results All the patients received healing by first intention after 21 to 34 days.There was no death. Aftera follow-up of 1 to 3 years, the appearance of scotum was satisfactory and no orchiatrophy occurred. Thirteen patients with testicles had normal sexual function. Conclusion After a definite diagnosis,early aggressive debridement,broad-spectrum antibiotics and sufficient local drainage should be used. If available,hyperbaric oxygen therapy may be used to promote healing of tissue wound. Scrotum should be rebuilt based on different conditions.
ObjectiveTo review the research progress of constructing injectable tissue engineered adipose tissue by adipose-derived stem cells (ADSCs). MethodsRecent literature about ADSCs composite three-dimensional scaffold to construct injectable tissue engineered adipose tissue is summarized, mainly on the characteristics of ADSCs, innovation of injectable scaffold, and methods to promote blood supply. ResultsADSCs have a sufficient amount and powerful ability such as secretion, excellent compatibility with injectable scaffold, plus with methods of promoting blood supply, which can build forms of injectable tissue engineered adipose tissue. ConclusionIn despite of many problems to be dealt with, ADSCs constructing injectable tissue engineered adipose tissue may provide a promising source for soft-tissue defect repair and plastic surgery.
Objective To evaluate the effect of the modified extended iliofemoral approach on treatingcomplex acetabular fractures. Methods Thirty-six cases of complex acetabular fractures were treated by the open reposition and internal fixation by a modified extended iliofemoral approach. Results Thirty-sixcases were followed up for 7-46 months, with an average of 23.8 months. According to the Matta standard, anatomical reposition was performed in 24 cases, perfect reposition in 8 cases, and unsatisfactory reposition in 4 cases. By the modified d’Aubignepostel score, among the 36 cases, 22 had an excellent result, 9 had a good result, and 5 had a poor result. Conclusion Themodified extended iliofemoral approach facilitates the operative exposure of the anterior and posterior walls and both columns of the acetabulum in the surgically-treated acetabular fractures by the open reposition and internal fixation.Because of the reconstruction, the functions of the abductor muscle mass managed by the lagscrew-fixed osteotomies of the iliac crest, and greater trochanter, the patients can achieve a rapid rehabilitation of the joint.
Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
Objectives To investigate the curative effect of skin flap and allogenic tendon in reconstructing l imbs function of complex soft-tissue defect. Methods From May 2001 to December 2007, 43 cases of complex soft-tissue defect of l imbs were repaired by pedicled skin flaps, free skin flaps, cutaneous nerve nutrient vessel skin flaps and arterial island skin flaps for primary stage, then the function of the l imbs were reconstructed with allogeneic tendon after 2-3 months of skin flapoperation. There were 31 males and 12 females, aged 5-53 years(mean 25 years). Injury was caused by machine in 28 cases, by traffic accident in 14 cases and others in 1 case. There were 27 cases in upper l imb, 16 cases in lower l imb. Twenty-six cases compl icated by bone fracture, dislocation and bone defect, the most of bone defect were cortical bone defect. The sizes of skin and parenchyma defect were 9 cm × 4 cm to 37 cm × 11 cm, the length of tendon defect was 6 to 26 cm. The sizes of skin flaps were 10 cm × 5 cm to 39 cm × 12 cm. Allogeneic tendons were used 2-6 strips(mean 4 strips). Results Forty-three cases were followed up for 5-56 months (16 months on average), all flaps survived. The donor area healed by first intention, the incision healed by first intention in second operation, and no tendon rejection occurred. The cl inical heal ing time of fracture was 3-8 months, and the cl inical heal ing time of allograft was 6-8 months. Six cases were given tenolysis for adhesion of tendon after 3-5 months of tendon transplantation. The postoperative flexion of wrist joint was 20-50°, the extension was 20-45°. Articulatio metacarpophalangea and articulatio interphalangeae could extend completely. The flexion of articulatio metacarpophalangea of thumb was 20-45°, the flexion of articulatio interphalangeae was 30-70°. The flexion of articulatio metacarpophalangea and articulatio interphalangeae of the other fingers was 60-90°. The postoperative ankle can extend to neutral position, the neutral position of ankle was 30-50°. The flexion of articulatio metatarsophalangeae and articulatio interdigital was 20-40°. Theextension of articulatio metatarsophalangeae was 30-60°. Conclusion Through designing systematically treatment plan,practicing operation by stages, preventing adhesion of tendon actively and exercising function reasonably, the functions of l imbs reconstructed by allogenic tendon and skin flap can leads to satisfactory effect.
Objective?To investigate the surgical method and clinical efficacy of repairing whole-hand destructive injury or hand degloving injury with the transplant of pedis compound free flap.?Methods?From February 2003 to June 2008, 21 patients with whole-hand destructive injury or hand degloving injury were treated, including 15 males and 6 females aged 18-45 years old (average 25 years old). The injury was caused by punching machine crush in 10 cases, roller crush in 7 cases, and imprinter crush in 4 cases. The time between injury and operation was 1-9 hours. Eleven cases had the skin-degloving injury of the whole hand, while the other 10 cases had the proximal palm injury combined with dorsal or palmar skin and soft tissue defect. After debridement, the size of wound was 9 cm × 7 cm - 15 cm × 10 cm in the dorsal aspect and 10 cm × 7 cm -16 cm × 10 cm in the palmar aspect. The defect was repaired by the thumbnail flap of dorsalis pedis flap and the second toenail flap of dorsalis pedis flap in 5 cases, the thumbnail flap of dorsalis pedis flap and the second toe with dorsalis pedis flap in 4 cases, and bilateral second toe with dorsalis pedis flap in 12 cases. The flap area harvested during operation ranged from 6 cm × 5 cm to 16 cm × 11 cm. Three fingers were constructed in 2 cases and two fingers in 19 cases. Distal interphalangeal joint toe amputation was conducted in the thumbnail flap donor site, metatarsophalangeal joint toe amputation was performed in the second toenail flap donor site, and full-thickness skin grafting was conducted in the abdomen.?Results?At 7 days after operation, the index finger in 1 case repaired by the second toenail flap suffered from necrosis and received amputation, 1 case suffered from partial necrosis of distal dorsalis pedis flap and recovered after dressing change, and the rest 42 tissue flaps survived. Forty-three out of 44 reconstructed fingers survived. All the wounds healed by first intention. At 2 weeks after operation, 2 cases had partial necrosis of the donor site flap and underwent secondary skin grafting after dressing change, the rest skin grafts survived, and all the wounds healed by first intention. Nineteen cases were followed up for 6-36 months (average 11 months). The flaps of palm and dorsum of hand showed no swelling, the reconstructed fingers had a satisfactory appearance and performed such functions as grabbing, grasping, and nipping. The sensory of the flaps and the reconstructed fingers recovered to S2-S4 grade. The donor site on the dorsum of the foot had no obvious scar contracture, without obvious influence on walking.?Conclusion?For the whole-hand destructive injury or hand degloving injury, the method of transplanting pedis compound free flap can repair the defect in the hand and reconstruct the function of the injured hand partially. It is an effective treatment method.