OBJECTIVE: Retrospective clinical analysis of primary surgical operation in the treatment of lower limb accompanied by chronic leg ulcer were adopted in this study. METHODS: From September 1990 to June 1998, there were 31 males and 20 females, aged 68 years in average, the area of ulcer varied from 5 cm x 3 cm to 22 cm x 11 cm. The ligation and strip of saphenous vein, debridement and free skin flap grafting were finished in primary operation. RESULTS: The skin flaps were survived completely in 50 cases, only 1 case was necrosis partially and healed after changing dressing. Forty-two cases were followed up for 16 months to 9 years (66 months in average), the varicosis and ulcer were healed in 39 cases and only 3 relapsed in ulceration. CONCLUSION: Primary surgical operation in the treatment of varicosis of lower limb accompanied by chronic ulcer is practicable in clinic. The curative efficacy is satisfactory and the operative manipulation is simple.
OBJECTIVE: To explore an effective method to repair the abdominal wall defect. METHODS: From July 1996 to December 2000, 7 cases with abdominal wall defect were repaired by pedicle graft of intestine seromuscular layer and skin graft, among them, intestinal fistula caused by previous injury during operation in 4 cases, abdominal wall defect caused by infection after primary fistulization of colon tumor in 2 cases, abdominal wall invaded by intestinal tumor in 1 case. Exploratory laparotomy was performed under general anesthesia, the infective and edematous tissue around abdominal wall defect was gotten rid off, and the pathologic intestine was removed. A segment of intestine with mesentery was intercepted, and the intestine along the longitudinal axis offside mesentery was cutted, the mucous layer of intestine was scraped. The intestine seromuscular layer was sutured to the margin of abdominal wall defect, and grafted by intermediate split thickness skin. RESULTS: The abdominal wall wound in 6 cases were healed by first intention, but part of grafted skin was necrosed, and it was healed by second skin graft. No intestinal anastomotic leakage was observed in all cases. Followed up 1 to 2 years, there were no abdominal hernia or abdominal internal hernia. All the cases could normally defecate. The nutriture of all cases were improved remarkably. CONCLUSION: Pedicle graft of intestine seromuscular layer is a reliable method to repair abdominal wall defect with low regional tension, abundant blood supply and high successful rate.
To discuss the advantages of two flap contouring methods and to explore the best choice for the flap contouring. Methods From March 2002 to March 2006, 59 patients were admitted for a flapcontouring operation. Of the 59 patients, 40 (32 males, 8 females; average age, 34 years) underwent the multiphase lipectomy (the multiphase lipectomy group). The original flaps included the abdominal flap in 19 patients, the groin flap in 10, the thoracic flap in 4, the free anteriolateral thigh flap in 6, and the cross leg flap in 1. The flaps ranged in size from 6cm×4 cm to 32 cm×17 cm. However, the remaining 19 patients (16 males, 3 females; average age, 28 years) underwent the onephase lipectomy with skin graft transplantation(the onephase lipectomy group). The original flaps included the abdominal flap in 4 patients, the groin flap in 6, the thoracic flap in 3, and the free anteriolateral thighflap in 6. The flaps ranged in size from 4 cm×3 cm to 17 cm×8 cm. The resultswere analyzed and compared. Results In the multiphase lipectomy group, partial flap necrosis developed in 4 patients but the other flaps survived. The followedup of 27 patients for 3 months to 2 years revealed that the flaps had a good appearance and texture, having no adhesion with the deep tissues. However, the flaps became fattened in 22 patients with their body weight gaining. The patietns who had a flap gt; 5 cm×5 cm in area had their sensation functions recovering more slowly; only part of the sensations to pain and heat recovered. The two point discrimination did not recover. In the onephase lipectomy group, total graft necrosis developed in 1 patient but the healing was achieved with additional skin graft transplantation; partial graft necrosis developed in 2patients but the wounds were healed after the dressing changes; the remaining flaps survived completely. The followup of the 16 patients for 3 months to 3 years revealed that all the 16 patients had a good sensation recovery, 12 patientshad the two point discrimination lt; 15 mm, with no recurrence of the fattening of the flaps; however, the grafted skin had a more severe pigmentation, and no sliding movement developed between the skin and the tissue basement. Conclusion The multiphase lipectomy and the onephase lipectomy with skin graft transplantation are two skin flap contouring methods, which have their ownadvantages and disadvantages. Which method is taken should be based on the repair location of the 〖WT5”BZ〗skin flap and the condition of the skin flap.
【摘要】 目的 探讨大面积手部皮肤脱套伤并缺损的修复方式。 方法 2005年6月－2010年1月，应用腹部皮瓣包埋和游离中厚皮片植皮结合负压封闭引流（vacuum sealing drainage，VSD）技术治疗手部大面积皮肤脱套伤合并缺损12例，其中男8例，女4例；年龄21~56岁，平均34岁。机器绞伤9例，车祸伤3例。所有损伤均合并肌腱、关节或骨质外露；软组织缺损范围为9 cm×8 cm~25 cm×18 cm。受伤至手术时间4~17 h，平均6.5 h。手掌及手指缺损部位采用腹部带蒂皮瓣包埋；手掌及手指以外肌肉、筋膜完好的部位采用大腿游离中厚皮片植皮，再于植皮表面覆盖VSD敷料，接负压行持续吸引；所有患者均二期断蒂并进行分指或皮瓣成形手术。 结果 术后2例手指部分皮瓣或植皮坏死，2例小部分皮瓣及植皮边缘坏死，经单纯换药后逐渐愈合，1例缺损较大、较深，先行换药，待创面肉芽新鲜后行二期植皮手术，愈合良好 。其余皮瓣及植皮均成活，创面Ⅰ期愈合；供区植皮均成活，切口均Ⅰ期愈合。12例均获6~42个月随访，2例手指末节软组织缺损严重、血运差，术后7~10 d末节坏死后短缩；3例掌侧皮瓣移植后较臃肿；其余外观均较满意。所有患者创面愈合后1个月内深、浅感觉功能均稍差，3~6个月逐渐恢复，但手指精细感觉恢复差，两点辨别觉为6~13 mm，平均9.5 mm。所有患手平均掌指关节主动活动50°，指间关节20°。 结论 腹部皮瓣包埋和游离中厚皮片植皮结合VSD技术能较好地修复手部大面积皮肤脱套伤并缺损，是一种实用、安全且简便的手术方法。【Abstract】 Objective To investigate the ideal repair method for large-area hand avulsed wound and soft tissue defects. Methods From June 2005 to January 2010, 12 patients with large-area hand avulsed wound and soft tissue defects were repaired with abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique. The patients included 8 males and 4 females with their age ranged from 21 to 56 years averaging at 34 years. The causes of injury were machine twist injury in 9 cases and road accident injury in 3 cases. All the injuries combined with exposure of tendon, joint or bone. The area of defects ranged from 8 cm×9 cm to 18 cm×25 cm. The time between injury and operation was 4 to 17 hours averaging at 6.5 hours. The palm of hand and fingers were repaired by abdominal pedicle skin flaps, and the dorsum of hand and wrist were repaired by skin grafting combined with vacuum sealing drainage. About 3 weeks later, all pedicles of the abdominal flaps were cut off and flaps plasty were carried out. Results All patients were followed up from 6 to 42 months with an average period of 17 months. All of the flaps and skin grafts survived. Only 6 patients had distal edge partial necrosis, and all of them healed after a short time of dressing changes or second-stage skin grafting. All skin grafts of the donor sites survived and all the wounds healed by first intention. All the injured hands recovered well to their original shape and function except partial bad skin sensation. The sense of two-point discrimination was from 6 mm to 13 mm with an average distance of 9.5 mm. The active motion of metacarpophalangeal joints averaged at 60°, and the interphalangeal articulations averaged at 30°. Conclusion Abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique can be used to repair large-area hand avulsed wound and soft tissue defects, and it is practical, safe and simple.
Objective To investigate the cl inical effect of Meek technique skin graft in treating exceptionally large area burns. Methods The cl inical data were retrospectively analysed from 10 cases of exceptionally large area burns treated with Meek technique skin graft from April 2009 to February 2010 (Meek group), and were compared with those from 10 casesof exceptionally large area burns treated with the particle skin with large sheet of skin allograft transplantation from January 2002 to December 2006 (particle skin group). In Meek group, there were 8 males and 2 females with an average age of 34.5 years (range, 5-55 years), including 6 cases of flame burns, 2 cases of hot l iquid burns, 1 case of electrical burn, and 1 case of hightemperature dust burn. The burn area was 82.6% ± 3.1% of total body surface area (TBSA). The most were deep II degree to III degree burns. The time from burn to hospital ization was (3.5 ± 1.3) hours. In particle skin group, there were 8 males and 2 females with an average age of 36.8 years (range, 18-62 years), including 5 cases of flame burns, 2 cases of hot l iquid burns, and 3 cases of gunpowder explosion injury. The burn area was 84.1% ± 7.4% of TBSA. The most were deep II degree to III degree burns. The time from burn to hospital ization was (4.9 ± 2.2) hours. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The skin graft survival rate, the time of skin fusion, the systemic wound heal ing time, and the treatment cost of 1% of burn area were 91.23% ± 5.61%, (11.14 ± 2.12) days, (38.89 ± 10.36) days, and (5 113.28 ± 552.44) yuan in Meek group, respectively; and were 78.65% ± 12.29%, (18.37 ± 4.63）days, (48.73 ± 16.92) days, and (7 386.36 ± 867.64) yuan in particle skin group; showing significant differences between 2 groups (P lt; 0.05). Conclusion Meek technique skin graft has good effect in treating exceptionally large area burns with the advantages of high survival rate of skin graft, short time of skin fusion, and low treatment cost of 1% of burn area.
Objective To evaluate the clinical outcomes of free perforator flaps combined with skin graft for reconstruction of ankle and foot soft tissue defects. Methods Between June 2014 and October 2015, 20 cases of ankle and foot soft tissue defects were treated. There were 16 males and 4 females, aged from 19 to 61 years (mean, 43.3 years). Injury was caused by traffic accident in 7 cases, by crashing in 9 cases, and machine twist in 4 cases. The locations were the ankle in 6 cases, the heel in 3 cases, the dorsum pedis in 4 cases, and the plantar forefoot in 7 cases of avulsion injury after toes amputation. The size of wound ranged from 15 cm×10 cm to 27 cm×18 cm. The time from injury to treatment was from 11 to 52 days (mean, 27 days). The anterolateral thigh perforator flap was used in 11 cases, thoracodorsal antery perforator flap in 3 cases, medial sural artery perforator flap in 4 cases, deep inferior epigastric perforator flap in 1 case, and anteromedial thigh perforator flap in 1 case, including 5 chimeric perforator flaps, 5 polyfoliate perforator flaps, 3 flow-through perforator flaps, and 3 conjoined perforator flaps. The size of the perforator flap ranged from 10.0 cm×6.5 cm to 36.0 cm×8.0 cm, the size of skin graft from 5 cm×3 cm to 18 cm×12 cm. Results Venous crisis occurred in 2 flaps which survived after symptomatic treatment; 18 flaps survived successfully and skin grafting healed well. The follow-up time ranged 4-18 months (mean, 8.3 months). The flaps had good appearance, texture and color, without infection. The patients could walk normally and do daily activities. Only linear scars were observed at the donor sites. Conclusion Free perforator flap can be used to reconstruct defects in the ankle and foot, especially in the weight-bearing area of the plantar forefoot. A combination of free perforator flap and skin graft is ideal in reconstruction of great soft tissue defects in the ankle and foot.
Objective To investigate the expression of c-kit in human intermediate-spl it-thickness skin grafts and normal skin, and to recognize the role of c-kit in hyperpigmented process of the skin grafts. Methods The hyperpigmented intermediate-spl it-thickness skin grafts of 16 patients’ face and cervicum 1 year after operation was harvested and the normal skins around the recipient site and the donor site were used as controls. Envision immunohistochemical technique was usedto detect the expression and distribution of c-kit in the skin grafts and in the normal control skins, respectively. Medical image quantitative analysis system was used to quantitate the positive expression index (PI). Results The expression of c-kit was located in endochylema and cytolemma of melanocytes and keratinocytes in the basilar part of epidermis. The positive expression of c-kit was obvious in the intermediate-spl it-thickness skin grafts and blown zone was observed in the basilar part of epidermis; and was not obvious and local in normal control skins. The PI of c-kit in the intermediate-spl it-thickness skin grafts (131 216 ± 19 130) was significantly higher than that in the normal skin around the recipient site (92 958 ± 16 208) and in the normal skin around the donor site (91 306 ± 8 135); showing statistically significant difference (P lt; 0.05). Conclusion The expression of c-kit in intermediate-spl it-thickness skin grafts increases remarkably compared with that in normal control skin. c-kit may play an important adjusting role in the process of hyperpigmentation of skin grafts．