Objective To explore the cl inical appl ication of rib autograft for reconstructing il iac crest by anterior approach of thoracic and lumbar vertebrae, and to observe the short-term and long-term effects. Methods From September 2004 to September 2007, 54 cases of thoracic and lumbar injuries were treated by the surgery of anterior approach of thoracic and lumbar vertebrae.There were 39 males and 15 females with an average age of 42 years old (range, 27-59 years old), including 4 cases of tuberculosis of spine and 50 cases of thoracic and lumbar vertebrae bursting fracture. All cases underwent the surgery of anterior approach of thoracic or lumbar and il iac crest was used as autograft. Fifty-four patients wererandomized into the reconstruction group (RG, n=25) and the non-reconstruction group (NRG, n=29). The patients of RGgroup were treated with rib autograft for reconstructing il iac crest. There were no statistically significant differences in general data between two groups (P gt; 0.05). The visual analogue scores (VAS) was used to estimate pain degree of treated hip after 2 weeks, and 3, 12 months. The extenion satisfaction grade of il iac crest and the comfort degree of action while bundl ing waist belt were estimated after 12 months. It was observed whether or not anterior superior il iac spine avulsion fracture occurred on the premise of non-accidental trauma within 1 year. The occurrence of fracture and the union status of reconstructed il iac crest were observed by X-ray after 1 year. Results All wounds achieved primary heal ing. No compl ication was found at early stage. All patients were followed up 1 year. There was no significant difference in the VAS of the treated hip under conditions of cl inostatism rest between two groups after 2 weeks and 3 months (P gt; 0.05). But there was significant difference in the VAS under conditions of action after 2 weeks and 3 months, under conditions of cl inostatism rest after 12 months (P lt; 0.05), and the VAS of RG was lower than that of NRG. The exterior satisfaction grade of il iac crest and comfort degree of action while bundl ing waist belt in RG were higher than those in NRG after 1 year, showing significant differences (P lt; 0.05). No anterior superior il iac spine avulsion fracture occurred after 1 year. And in RG group no fracture of reconstructed il iac crest occurred after 1 year. The X-ray film showed that the two ends of rib reconstructed by il iac crest were blur, and that the rib healed well with il iac bone. Conclusion Rib autograft for reconstruction of il iac crest by anterior approach of thoracic and lumbar vertebrae was economic and convenient. It could improve local appearance, reduce the local pain, and improve patients’ l ife quality.
【Abstract】Objective To investigate the effect of donor blood transfusion on inducing pancreatic allograft tolerance in outbred rat model. Methods Wistar male rats were used as blood and pancreas donor, and diabetic recipients. One ml of donor blood injected into abdomen of diabetic recipients on the day of transplantation and azathioprine given 2 days pretransplant and continued for three days. Results Pancreas allograft survival was significantly prolonged (28 to 112 days, media survival time 64.2 days). One ml of donor blood alone injected into the abdomen and azathioprine given alone 2 days pretransplant did not improve allograft survival (media survival time 9.8 vs 10.2 days). Conclusion Donor blood injected on the day of transplantation and a 3 days course of azathioprine started 2 days pretransplant have b synergism in inducing long term graft survival in this rat model.
Objective To investigate the donor-site compl ications of the anterolateral thigh flap and its influencing factors. Methods Between July 1988 and July 2007, 427 patients were treated with anterolateral thigh flap. Among them, 33 patients had postoperative donor-site compl ications and their cl inical data were analyzed retrospectively. There were 21 malesand 12 females aged 14-47 years old (average 32.7 years old). The size of the wound defect ranged from 16 cm × 7 cm to 28 cm × 13 cm. The area of the flap harvested during operation ranged from 16 cm × 7 cm to 30 cm × 13 cm. The donor sites were treated by direct suture in 7 cases; free spl it-thickness skin graft in 23 cases, and reverse superficial epigastric artery flap repair in 3 cases. The size of graft in the donor site ranged from 10 cm × 5 cm to 18 cm × 8 cm. The occurrence of short-term (within 4 weeks) and long-term (over 6 months) compl ications were analyzed. Results All patients were followed up for 8-54 months (average 21 months). There were 26 patients (78.8%) with short-term and long-term compl ications and 7 patients (21.2%) with long-term compl ications. The short-term compl ications included skin graft necrosis in 23 cases (69.7%), wound infection in 17 cases (51.5%), and muscle necrosis in 2 cases (6.1%). The long-term compl ications included non-heal ing wounds in 21 cases (63.6%), serious scar in 28 cases (84.8%), discomfort in 25 cases (75.8%), and dysfunction of the quadriceps femoris in 16 cases (48.5%). Conclusion The occurrence of anterolateral thigh flap donor-site compl ications is related to the anatomical structure of the anterolateral thigh region, the surgical procedure, and the patient’s physique.
OBJECTIVE: To investigate the method of improving the vitality of skin graft on donor site of the great toe-nail skin flap. METHODS: From June 1982 to April 1998, 252 cases of the great toe-nail flaps with piece of phalangeal bone and 18 cases of the simple great toe-nail flap were repaired with thin skin graft and packed under proper pressure. The stitches were removed two weeks later in common situation. It should be postponed on split thickness or partial survival skin flap avoiding early mobilization. RESULTS: Sixty-six cases of skin graft were necrotic after operation. Among them, 38 cases needed second skin grafting and 28 cases were healed after changing dressing. The survival rate of skin grafting was obviously higher on phalangeal marrow surface than on periosteum of the naked phalange. Contracture of the skin graft after operation made the retained skin flap expanding from medial side to lateral side and covered the whole plantar surface of the great toe. CONCLUSION: The survival rate of the skin graft on donor foot is improved after adopting the improved measures on taking the flap from great toe and paying attention to skin graft planting and packing. Free flap grafting is advocated for repairing of the wound on donor area of the great toe nail flap.
Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts. Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (Pgt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.
The experience on management of abnormal blood vessels in 128 cases of donor kidney during the tailoring operation was reported. The various techniques used for different types of abnormal arteries and veins, and the critical points which should be paid attention to have been discussed. It was concluded that the multiple renal arteries should be treated in a single renal artery and anastomosed with internal iliac artery or/and external iliac artery. The appropriate management given to abnormal renal blood vessels during the tailoring operation may shorten the warm ishemia time, ensure the renal blood supply, reduce the renal vasular complication, and promote the recovery of renal function.
Objective To get the information about the cognition and attitude towards organ transplantation and donation in inpatients. Methods The inpatients were investigated by using a self-designed questionnaire，including general data，cognition and attitude towards organ transplantation and donation. The influence factors of organ transplantation and donation were analyzed by SPSS 18.0. Results A total of 1 000 questionnaires were delivered，973 returned，the effective questionnaire was 906，and the effective rate was 93.1%. In 906 valid questionnaires，788 （87.0%） patients knew organ transplantation；189 （20.9%） patients had transplanted relatives；511 （56.4%） patients were willing to accept the organ transplant surgery，226 （24.9%） patients did not want，169 （18.7%） patients did not know；490 （54.1%） patients agreed to donate organ，173 （19.1%） patients disagreed，243 （26.8%） patients did not know. The age，education，occupation，knowing organ transplants，and with organ transplanted relatives or not had significant influences to the willingness towards organ transplantation and donation （P＜0.01）. The gender had no effect on organ transplantation （P=0.727） and donation （P=0.935） concerned issues，but the age，education，knowing organ transplantation，and with organ transplanted relatives or not had significant influences on it （P＜0.01）. Most concerned factors about organ transplantation were as follows：with an available organ for transplantation 〔28.7% （260/906）〕，postoperative quality of life 〔23.0% （208/906）〕，risk of surgery 〔21.5%（195/906）〕，surgery costs 〔19.5% （177/906）〕，and postoperative rejection 〔7.3% （66/906）〕. Most concerned factors about organ donation were as follows：the reasonable usage of donated organs 〔57.4% （520/906）〕，attitude of relatives 〔23.8% （216/906）〕，and donation compensation 〔17.6% （159/906）〕，and others 〔1.2% （11/906）〕. According to the way of organ donation，403 （44.4%） patients were willing to accept donation after cardiac death （DCD），257 （28.4%） patients accept donation after brain death，246 （27.2%） patients accept living organ donation. The gender，education，and occupation had significant influences on the way of organ donation （P＜0.05），but age，knowing organ transplantation，and with organ transplanted relatives or not had no effects on it （P＞0.05）. Conclusions The lack of propaganda and the high costs of transplantation surgery are the main factors restricting the acceptance rate of organ transplantation. Over time，with continuous improvement of universal education and strengthening the publicity of organ transplantation，the acceptance rate will show a constant increase in the trend. By now，the most accepted way of organ donation is DCD in inpatients. The establishment of a reasonable organ allocation and compensation system is a corner stone to promote organ donation.
Abstract: Although lung transplantation has been established as the only valid therapeutic approach for endstage pulmonary disease, several related problems remain to be solved. In addition to the serious problem in donor lung shortage, primary graft dysfunction caused by lung ischemia-reperfusion injury is one of the most common reason of early mortality. Optimal preservation of lung is essential to reduce ischemic organ dysfunction after lung transplantation. The development of a highly reliable lung preservation solution that reduces ischemia-reperfusion injury will improve the functioning of transplanted lungs. The progress of the type, perfusing technique or strategies and modified methods of lung preservation solution are reviewed in this article.
Objective To explore the donor maintenance points of donor donation after brain death （DBD）. Methods From December 2011 to January 2012，two cases of organ DBD in our hospital were performed. After diagnosis of brain death，mechanical ventilation，fluid resuscitation，vasoactive drugs，inotropic drugs，and so on were used，and invasive arterial pressure， central venous pressure，heart rate，blood gas exchange，urine output，electrolyte and acid-base balance，body temperature， hematocrit，albumin level were monitored，the donors vital organ perfusion were successfully kept at acceptable level. Results The vital signs of two cases of DBD donors were stable. The livers，kidneys，and corneas were donated，and the functions were stable and normal. Case one was diagnosed for brain death 6h after ICU admitted，the period from diagnosis to organ procurement was 33h. Case two was diagnosed for brain death 8h after ICU admitted，the period from diagnosis to organ procurement was 31h. All transplanted organs，livers，kidneys，and corneas，were working well after operation. Conclusions Donor maintenance process of DBD is the cornerstone to ensuring successfully organ donation and transplantation，which is important to improve the utilization rate of donated organs，and release the severely shortage of organ.
ObjectiveTo discuss the effectiveness of free croin flap in repairing defects of donor after toe or feet tissue flap transplantation. MethodsBetween March 2010 and May 2015, 23 cases of defects of donor after toe or feet tissue flap transplantation were repaired with free croin flap and followed up for more than 6 months, and the clinical data were retrospectively analyzed. There were 15 males and 8 females, with an age range from 17 to 52 years (mean, 25.6 years). All finger or soft tissue defects were caused by trauma. Defects were repaired in emergency operation with toe or feet tissue flap transplantation in 18 cases, defects were secondarily reconstructed at 3-8 months after injury in 5 cases. The defect area at the feet donor site ranged from 3 cm×3 cm to 10 cm×6 cm, all accompanied with exposure of bone, and tendon. The area of free croin flap was 3.5 cm×3.5 cm-11.0 cm×6.5 cm, the vessel of flap was anastomosed with artery and vein of foot. The inguinal donor site was sutured directly. ResultsThe operation time was 3-9 hours (mean, 4.5 hours); the intraoperative blood loss was 50-300 mL (mean, 120 mL). Vessel crisis occurred in 1 case postoperatively; mild and moderate swelling occurred in 3 cases, with small sporadic blisters formation; free croin flap survived completely in the other cases, and primary healing was obtained at feet wound and inguinal donor sites. Twenty-three cases were followed up 6-24 months (mean, 9 months). The color and texture of the croin flaps were similar to that of the adjacent skin, no obvious scar contracture and pigmentation were observed; the patient could walk with weight loading, the two-point discrimination was 18-35 mm (mean, 26 mm) at 6 months after operation. The color, texture, and shape of reconstructed finger was good; the function of grasping and pinching recovered well; the two-point discrimination was 5.5-11.0 mm (mean, 6.5 mm) at 6 months after operation. According to upper extremity functional evaluation standard by Chinese Medical Association, the results were excellent in 18 cases and good in 5 cases. ConclusionFree croin flap can effectively repair skin and soft tissue defects of donor after toe or feet tissue flap transplantation, and good function and appearance of feet can be obtained.