Various tissue flaps were used in the repair of 255 cases of the wounds from severe deep burns and cicatricial deformities. The types of flaps used included: 6 kinds of myocutaneous flaps in 54 cases, 10 kinds of axial cutaneous flaps in 50cases, 7 kinds of fasciocutaneous flaps in 44 cases, pedicled subcutaneous tissues flaps in 12 cases, pedicled thin skin flaps in 54 cases, subdermal vascular networks cutaneous flaps in 38 cases, and free skin flaps with arter ialization of vein flap, retrograd island cutaneous flap with great or small saphaneous vein, in each. The survival rate from the transplantation was 99.2 per cent, and the rate of primary healing was 94.5 per cent. According to the time interval between the injury and operation and the conditions of the wounds, the patients were divided into acute, infected and selective cases, and the rate of primary healing was 93.0 per cent, 91.6 per cent and 97.9 per cent, respectively. The selection of the types of flap to be used and the attentions to be taken dueing operation were discussed.
ObjectiveTo evaluate the effectiveness of different flaps for repair of severe palm scar contracture deformity. MethodsBetween February 2013 and March 2015, thirteen cases of severe palm scar contracture deformity were included in the retrospective review. There were 10 males and 3 females, aged from 14 to 54 years (mean, 39 years). The causes included burn in 9 cases, hot-crush injury in 2 cases, chemical burn in 1 case, and electric burn in 1 case. The disease duration was 6 months to 6 years (mean, 2.3 years). After excising scar, releasing contracture and interrupting adherent muscle and tendon, the soft tissues and skin defects ranged from 6.0 cm×4.5 cm to 17.0 cm×7.5 cm. The radial artery retrograde island flap was used in 2 cases, the pedicled abdominal flaps in 4 cases, the thoracodorsal artery perforator flap in 2 cases, the anterolateral thigh flap in 1 case, and the scapular free flap in 4 cases. The size of flap ranged from 6.0 cm×4.5 cm to 17.0 cm×7.5 cm. ResultsAll flaps survived well. Venous thrombosis of the pedicled abdominal flaps occurred in 1 case, which was cured after dressing change, and healing by first intention was obtained in the others. The mean follow-up time was 8 months (range, 6-14 months). Eight cases underwent operation for 1-3 times to make the flap thinner. At last follow-up, the flaps had good color, and the results of appearance and function were satisfactory. ConclusionSevere palm scar contracture deformity can be effectively repaired by proper application of different flaps.
ObjectiveTo study the treatment results of the pre-expanded flaps for scar contracture on face, neck, and joints by comparing with the skin grafts. MethodsA total of 240 cases of scar contracture between July 2004 and June 2014 were included in the study by random sampling; skin grafts were used in 120 cases (skin graft group), and preexpanded flaps in 120 cases (pre-expanded flap group). There was no significant difference in age, sex, injury sites, and disease duration between 2 groups (P>0.05). Re-operation rate and A&F 0-6 quantization score were used to evaluate the treatment results. ResultsThe patients were followed up 12 to 75 months (mean, 23.47 months) in the skin graft group, and 12 to 61 months (mean, 19.62 months) in the pre-expanded flap group. The re-operation rate of the skin graft group was 72.5% (87/120), and was significantly higher than that of the pre-expanded flap group (19.2%, 23/120) (P=0.000). The re-operation rate of the neck contracture in teenagers was the highest. It was 93.9% in the skin graft group and 35.0% in the pre-expanded flap group. In the patients who did not undergo re-operations, A&F 0-6 quantization score of the skin graft group was 2.85±1.12, and was significantly lower than that of the pre-expanded flap group (5.22±0.74) (t=13.830, P=0.000). ConclusionPre-expanded flap for scar contracture on face, neck, and joints has lower re-operation rate and better aesthetic and functional restoration than skin graft. It should be regarded as the preferred method for teenagers.
OBJECTIVE To investigate the different expression of actin, myosin II in hypertrophic scars, keloids and normal skins, and to understand the relationship of actin, myosin II and the scar contracture. METHODS Fifteen cases with hypertrophic scars, 10 cases with keloids and 15 cases with normal skins were chosen randomly. The expression of actin and myosin II were detected by immunohistochemical method in the hypertrophic scars, keloids and normal skins. The fibroblasts isolated from three types of tissue were cultured in vitro, then actin and myosin II in three different fibroblasts were measured using flow cytometry. RESULTS The immunohistochemical staining of myosin II in hypertrophic scars was positive, while the staining in keloids and normal skins were negative. The positive rate of myosin II expression in hypertrophic scars, keloids and normal skins were (95.11 +/- 2.78)%, (16.86 +/- 7.11)%, and (5.31 +/- 1.79)% respectively. There were significant difference between keloids and the two others(P lt; 0.01). The actin expression in three difference tissues were positive, there were no significant difference in hypertrophic scars, keloids and normal skins(P gt; 0.05). The positive rate of actin expression in hypertrophic scars, keoids and normal skins were(77.77 +/- 15.43)%, (88.89 +/- 10.29)%, and (82.92 +/- 13.48)% respectively, and there were no significant difference(P gt; 0.05). CONCLUSION Myosin II may play an important role in the scar contracture. Actin is the contractile protein of cell, it plays
Objective To investigate the benefit of the combined therapy for deformed fingers after burn injury by compairing with the conventionalone,and to sum up some experience. Methods From June 1999 to June 2004, 56 patients with deformed fingers entered the trial. In 28 patients of treatment group who received combined therapy(operation with postoperational systematic convalescent care, group A), there were 20 males and 8 females (14-47 years), 129 fingers of 47 hands were involved. In 28 of conventional group who received conventional therapy (the same operational principle, and self-convalescent-care with out-patient service guidance, group B), there were 17 males and 11 femals (18-51 years), 107 fingers of 42 hands were involved. Before and afterthe therapy, the finger’s motor function were assessed according to the Swansonmethod. The hand’s motor function was assessed through the Nine Hole Peg Test. Results The follow-up was 12-19 months in group A and 13-20 months in group B. The index of ankylosis (IA) of group A before therapy was82%±20%, and 45%±13% after theraphy; while the IA of group B before therapy was 78%±17%, and 52%±14% after therapy. The decreased of IA between before therapy and after therapy was 37%±15% in group A, and 26%±15% in group B, showing significant difference between the two groups (P＜0.05) . The Nine Hole Peg Test value of group A was 28.34±5.62s before therapy, and 20.73±4.25 s after therapy; while that of group B was 27.47±5.78 s before therapy, and 21.86±4.12 s after therapy. The decrease of the Nine Hole Peg Test value between before therapy and after therapy was 7.61±2.27 s in group A, and 561±294 s in group B, showing statistically significant difference (P＜0.05). Conclusion The combined therapy is more effective than the conventional one.
ObjectiveTo discuss the feasibility and effectiveness of link-pattern lateral popliteal artery perforator flap in repairing popliteal fossa scar contracture in children or teenagers. MethodsBetween January 2009 and January 2013, 12 patients with popliteal fossa scar were admitted. Of them, 7 cases were male and 5 cases were female, aged from 3 to 17 years (median, 12 years). The disease duration was from 6 months to 5 years (median, 3 years). Wound was repaired with link-pattern lateral popliteal artery perforator flap after remission of popliteal fossa scar. The wound ranged from 6 cm×4 cm to 10 cm×7 cm, and the flap size ranged from 7 cm×4 cm to 12 cm×9 cm. The flap was with lateral sural cutaneous nerve in 5 cases, and lateral sural cutaneous nerve was retained at the donor area of 7 cases. The donor site was repaired using split-thickness skin graft. ResultsAll pedicled flaps and skin graft survived smoothly after operation. The wound at donor site healed by first intention. All the cases were followed up 12-36 months, with an average of 18 months. The flaps had good color, texture, and shape; scar obviously became softened, without hyperplasia or ulceration. The patients were free from lameness with knee range of motion of 0-180°. The squatting function was normal. Grafting skin was smooth in the donor area of the calf, without depression or scar hyperplasia. The senses of posterior-inferior calf and lateral of foot decreased or disappeared in 5 cases of flaps with lateral sural cutaneous nerve; at 6 months after operation, two-point discrimination was 12-14 mm (mean, 13 mm). The posterior-inferior calf was numb and discomfort in 7 cases of flaps with retained lateral sural cutaneous nerve; but after 3-6 months, the sense was obviously recovered, with no sense loss; at 6 months after operation, two-point discrimination was 5-7 mm (mean, 6 mm). ConclusionLink-pattern lateral popliteal artery perforator flap has reliable blood supply and the operation was simple. The cutaneous nerve can be retained in donor area. It is an ideal method for repairing wound after remission of popliteal fossa scar in children or teenagers.
Objective To investigate the feasibility and effectiveness of thoracodorsal artery perforator (TDAP) flap for repairing serious scar contracture of the opisthenar. Methods Between March 2015 and June 2017, 7 cases of serious scar contracture of opisthenar were repaired with TDAP flaps. There were 5 males and 2 females with an average age of 31 years (range, 11-48 years). The time from injury to operation was 8-67 months, with an average of 42 months. After the relocation of the joint and release of the scar, the size of soft tissue defect ranged from 5 cm×4 cm to 10 cm×8 cm. The size of TDAP flap ranged from 5.5 cm×5.0 cm to 10.5 cm×9.0 cm. Results All flaps survived completely with primary healing at both donor site and recipient site. The flaps of 3 patients were bulky and underwent second-stage skin flap thinning at 3 months after operation. All 7 patients were followed up 6-32 months, with an average of 15 months. The skin flaps were soft and elastic. According to the upper limb function evaluation system recommended by Chinese Society of Hand Surgery, sensory function was classified as \begin{document}$\small{{\rm{S}}_{{{\scriptsize 3}^ + }}}$\end{document} in 2 cases, \begin{document}$\small{{\rm{S}}_{{{\scriptsize 3} }}}$\end{document} in 1 case, \begin{document}$\small{{\rm{S}}_{{{\scriptsize 2} }}}$\end{document} in 3 cases, and \begin{document}$\small{{\rm{S}}_{{{\scriptsize 1} }}}$\end{document} in 1 case. The hand function was excellent in 2 cases, good in 4 cases, and fair in 1 case. There was no significant effect on shoulder movement. Conclusion The TDAP flap is an ideal method for serious scar contracture of opisthenar.
Free calcium ions, as a kind of message-transport substance, is important in cellular activity such as cell movement, cell differentiation and cell proliferation. In order to investigate the relationship between free calcium ions and scar contracture, the fibroblasts which originated from hypertrophic scar, keloid and normal skin were used as the experimental target. The fibroblasts from 4th-6th generations of different sources were used; Then the intracellular free calcium ions concentrations were measured respectively by the fluorescent Ca2+ indicator Fura-2/AM and Image analysis system. The results showed that the level of Ca2+ in fibroblasts of hypertrophic scar was higher than that in keloid and normal skin (P lt; 0.01). There was no significant difference between the level of Ca2+ in keloid and in normal skin. The conclusion was that the concentration of intracellular free calcium ions played an important role in the scar contract, but the exact mechanism was still unclear and required further study.