Objective To evaluate the clinical effect of repair of massive bone defect in tibia by vascularized fibula grafting of either sides. Methods Twenty-four cases of massive bone defect in tibia, among which 14 cases were repaired by vascularized fibula grafting of the other side and another 10 cases were repaired by those of the same side, from 1987 to 1997 were followed up for 3 to 13 years; the functions of the operated limbs were evaluated according to Enneking Score System, and the outcome of the fibula grafts were assessed by radiographic examination with reference to the standard established by International Symposium onLimb Salvage. Results The average recover rate of the operated limbs in those repaired by the other side grafting was 80.7%, and the average healing period ofthe fibula graft was 14 weeks with fracture of the graft in one case which madethe operated lower limb shorten for about 2.5 cm; the fibula grafts were observed thickened in 43 weeks, on average, and the patients could walk independently without a crutch. While in those repaired by the same side grafting, the averagerecover rate of the operated limbs was 68.3%, the average healing period of thefibula graft was 17 weeks with fracture of the graft in 3 cases, in 2 of which the lower limbs were shortened for 2 cm and 4 cm respectively, and in the third one infection occurred and amputation was performed finally; the fibula grafts were observed thickened in 49 weeks, on average, which made it available for the patients to walk without a crutch. All of the data showed that there was a significant difference statistically between the differently treated cases. Conclusion It’s a good choice to repair massive bone defect in tibia by vascularized fibula grafting, and the vascularized fibula graft from the other side could promote the bone healing and accelerate the recover of the function of the operated lower limb.
Objective To investigate the feasibility of repairing thyroid cartilage defects by implantation of chondrocyte-allogenous acellular cartilaginousmatrix(chondrocyte-ACM) composite in rabbits. Methods The thyroid chondrocyteswere isolated and co-cultured in vitro with allogenous acellular cartilaginousmatrix(ACM) to form the chondrocyte-ACM composite. The composite was analyzed histologically and was used to repair defects of thyroid cartilage. Eighteen New Zealand adult rabbits were made the defect models of thyroid cartilage at the two sides and divided into three groups. The defects were repaired with chondrocyte-ACM composite in the experimental group(n=6), with simple ACM in the ACM group (n=6)and without any material in the control group(n=6). The animals were sacrificed at 8 weeks after operation. The specimens were evaluated histologically. Results In vitro, the growth of chondrocytes was observed on the surface of allogenous acellular cartilaginous matrix and no chondrocytes grew inside the matrix. The defect filled with muscle and connective tissues in control group; the lymphocyte infiltration was observed in the matrix and no new cartilage formationoccurred at 8 weeks after operation in simple ACM group and experimental group.So the defect repair of rabbits thyroid cartilage failed. Conclusion The allogenous acellular cartilaginous matrixfailed to serve as a scaffold for chondrocytes both in vitro and in vivo. The allogenous acellular cartilaginous matrixshould be improved.
Objective To evaluate the ability of inductive osteogenesis of allgraft demineralized bone containing basic fibroblast growth factor (bFGF/ALB) in repairing bone defect. Methods Thirty-two New Zealand white rabbits were randomly divided into four groups (groups A,B,C and D, n=8). A segmental bone defect of15 mm inlength was made on the bilateral radius respectively and the defects filled with ALB/bFGF in group A, with ALB in group B, with bFGF in group C and without any materials in group D serving as blank control. At 2, 4, 6 and 8 weeks after operation, all restored bones were evaluated by roentgenography, histological observation and Ca2+detection of osteotylus. Results The X-ray films showed that groups A and B had a little shadow of bone formation at 2 weeks, while groups C and D had transparent shadow; that group A had denser shadow and new bone formation at 4 weeks and 6 weeks, groups B and C had a little increase of shadow and group D had little shadow at fractured ends; and that group A had formation of bone bridge at 8 weeks, the new formed bone in fractured ends of group B closed with each other, the gap still existed in group C, and the defects filled with the soft tissue in group D. The Ca2+content of group A was higher than that of groups B, C and D at 4 weeks (Plt;0.05) and 8 weeks (Plt;0.01). The histological observaton showed that the degree of bone restoration of group A was superior to that of groups B, C and D. Conclusion bFGF/ALB is a good material to improve bone restoration.
Objective To explore an improved method of reconstructing the scalp soft tissue defect with the expanded skin soft tissue and treating and preventing the related complication. Methods From October 2002 toJune 2005, 32 patients (20 males and 12 females, aged 5-48 years) underwent reconstruction of the scalp soft tissue defects with the expanded scalp soft tissue in thetwo-stage operation. In the first stage, a tissue expander (cylindrical form, 50-250 ml) was inplanted into the skin to achieve a skin soft tissue expansion. After a sufficient skin expansion (8 cm×5 cm to 25 cm×23 cm) was made by the routine water affusion for 6-16 weeks, a properly-designed skin flap was taken and transferred to reconstruct the scalp soft tissue defect in the second-stage of the operation. All the scalp defects were left after the resections of the scalp lesions, which ranged in size from 7 cm×5 cm to 20 cm×20 cm.Results After operation, all the 32 patients had their scalp defects repaired and reconstructed well.The expanded skin flaps of all the 32 patients survived except 1 patient who had a necrosis of the distal epidermis of the flap, which healed after the dressings of the wound. The hair grew well and the scars were hidden with a satisfactory appearance. Four patients developed complications (necrosis of the distal flapin 1 patient, hematoma in 1, expander exposure in 1, and wound rupture in 1).Conclusion Reconstruction of the scalp soft tissue defect with the skin soft tissue expansion is an ideal method.
Objective To study the biological characteristic and potential of chondrocytes grafting cultured on fascia in repairing large defect of articular cartilage in rabbits. Methods Chondrocytes of young rabbits were isolated and subcultured on fascia. The large defect of articular cartilage was repaired by grafts of freeze-preserved and fresh chondrocytes cultured on fascia, and free chondrocytes respectively; the biological characteristic and metabolism were evaluated bymacroscopic, histological and immunohistochemical observations, autoradiography method and the measurement of nitric oxide content 6, 12, 24 weeks after grafting. Results The chondrocytes cultured on fascia maintained normal growth feature and metabolism, and there was no damage to chondrocytes after cryopreservation; the repaired cartilage was similar to the normal cartilage in cellular morphology and biological characteristics. Conclusion Chondrocytes could be cultured normally on fascia, which could be used as an ideal carrier of chondrocytes.
Objective To investigate the results and applicationvalue of crotch-shaped vein grafts in repairing defects of the vessels with a large diameter.Methods From June 1998 to October 2003, 35 cases of vesseldefects with a large diameter were repaired with crotch-shaped vein graft (29 males and 6 females,aged 18 to 45 years with an average of 25.7 years ). The locations of defects were femoral artery in 25 cases, popliteal artery in 2 cases, femoral vein in 7 cases, and subclavian vein in 1 case. The interval between injure and operatioinwas 1-8.5 hours (4.1 hours on average).The blood flows of trouble and healthy vascular were determined with Doppler detector and compared preoperatively andpostoperatively. Results All the anastomotic stomas were patent in 35 cases. Thirty-one cases were followed up 6 weeks to 24 months (9.5 months on average), the patent rate was 100%, no case occurred vasospasm or tromboembolism; 2 cases occurred stomal leak and became hematoma, 3 cases occurred muscular necrosis, and the 5 cases achieved primary healing after secondary operation. The Doppler results showed that there was statistically significant difference in the blood flow betweenpostoperation and preoperation (Plt;0.01), but no statistically significant difference when compared the trouble vascular after operation with healthy vascular (Pgt;0.05). Conclusion The methodof crotch-shaped vein grafts is safe and effective in repairing defects of vessels with a large diameter,which is easy to draw materials and handy to operate. It has a promising value in clinical application.
Objective To investigate the outcome of repairing hand composite defects using pedicle osteocutaneous groin flap. Methods From February 1998 to May 2004, 33 cases of hand composite defects were repaired with pedicle osteocutaneous groin flap. There were 22 males and 11 females. The age was 19 to 54 years with an average of 243 years. The defect was caused by palmar penetrating injury in 17 cases, by dorsal hand crushing injury in 9 cases and by other injury in 7 cases. Twentythree cases complicated by metacarpal defect, 10 by phalanx defect. Thesize of skin defect was 3.5 cm×2.0 cm to 15.0 cm×10.0 cm, the size of bonedefect was 1.5 to 3.5 cm. After 3 to 7 days of primary debridement, defect was repaired by the pedicle osteocutaneous groin flap based on the superficial circumflex iliac vessels. The flap size was 4.0 cm×2.5 cm to 17.0 cm×11.0 cm. Results All the osteocutaneous flaps survived. During the 4 to 22 months follow-up postoperatively, thetexture, appearance and function of the flap were excellent and bone union was obtained in all cases after 7 to 9 weeks of operation.Conclusion The pedicle osteocutaneous groin flap is an ideal flap to repair the composite defect of the hand, with the benefit of simple procedure and reliable blood supply.
Objective To investigate the therapeutic effectof infected incision wounds after sternotomy by using different reconstructive methods. Methods From December 1997 to December 2006, 13 patients (8 males, 5 females; age, 28-72 years averaged 52 years) with infected incision wounds after sternotomy underwent the reconstruction surgery respectivelyusing the pectoralis major muscle flaps, the medial flaps of the pectoralis major muscle, the rectus abdominis muscle flaps or the greater omentum transpositions. Among the patients, 8 were complicated by diabetes mellitus, 4 by pneumonia and heart failure, 3 by empyema, 4 by chronic insufficiency of the pulmonary function, 1 by malignant tumor, and 6 by severe obesity. Freshlysplit wounds werefound in 11 patients and chronic wounds in the other 2 patients.The size of thewounds was 10cm×5cm-22cm×10cm. Results Among the 13 patients，10 survived after operation and the other 3 died of massive hemorrhage from the anastomostic rupture of the blood vessel, pneumonia, and cancer metastasis, respectively. Of the 10 patients, 6 had their wounds healed by first intention. The follow-up for 6 months to 5 years revealed that there was no recurrencein all the survived patients. Of the 10 patients, 2 developed partial necrosisof the skins at the sutured wounds, which was healed after the skin grafting operation; 2 had an infection at the drainage area but had a healing after the dressing changes. Conclusion The smaller wounds in the upper partof the sternotomy incision should be repaired with the medial flaps of the pectoralis major muscle; the greater wounds in the upper part of the incision shouldbe repaired and reconstructed with the rectus abdominis muscle flap; the smaller wounds in the lower part of the incision should be repaired with the pectoralis major muscle flap, and if the wounds are longer, they should be repaired and reconstructed with the pectoralis major muscle flap and the rectus abdominis muscle flap; and if the wounds are huge enough with an exposure of the important internal organs, the greater omentum transposition should be used, and the residual wounds should be treated with dressing changes and even skin grafting.
Objective To investigate the ability of the biodegradable polycaprolactone (PCL) material to repair bone defect and to evaluate the feasibility ofusing the PCL as the scaffold in tissue engineering bone. Methods The bone defect models of 4.5 mm×12 mm were made in the bilateral femoral condyle of 65 NewZealand white rabbits. The PCL cylinder was implanted into the right side of defect(experimental group, n=60), the high dense crystality hydroxyapatite was implanted into the left side of defect (control group, n=60), and the incision was sutured without any implants (blank group, n=5). The samples were harvested and observed by examinations of gross, X-ray, bone density,99mTc-MDP bone scanning, γ-display ratio and scanning electron microscope (SEM) after 3, 6, 9 and 12 months of operation. The results were compared between the experimental group and control group. Results At 3, 6, 9 and 12 months after operation, the gross and X-ray examinations indicated that the bone defect filled with the new bone onthe PCL-tissue surface, and no delayed inflammatory reaction appeared. The average bone mineral density was greater in the experimental group than that in the control group, and the difference had statistical significance(P＜0.05). Theresults of 99mTc-MDP bone scanning and γ-display ratio showed that thenuclide uptake was more in the PCL group than that in the control group. The SEM result proved that the new compact bone formed on the PCL migrating surface as the PCL degraded gradually，but the collagen fiber sheathe formed around the hydroxyapatitein the control group. Conclusion PCL possesses good biocompatibility and high bone inductive potentiality, it can be used to repair bone defect.
Objective To introduce the experience and comprehensionto reconstruct nasal defect after tumor excision. Methods FromApril 1996 to April 2006, based on the aesthetic subunit principle and according to the size, shape, location of nasal defect and the conditions of surrounding skin, homologous local flap was selected to cover the nasal defect in 428 cases which nasal tumors were removed. Among 428 cases, there were 273 men and 155 women, with a median age of 52 years (12-78 years); including 146 cases of basal cell carcinoma, 83 cases of squamous cell carcinoma, 54 cases of epidermal cyst, and 145 cases of pigmented naevus.The clinical stage of malignant tumor was 0-Ⅰstage, the course of disease was 1 week to 3 months. The locations were nasal tip in 51 cases, nasal ala in 102 cases, dorsum of nose in 138 cases, and nasal side in 137 cases, across 2 nasal subunits in 83 cases. The area of thedefect ranged between 0.6 cm×0.6 cm and 3.0 cm×4.0 cm. The origin of flaps was frontonasal flap in 58 cases, bilobed flap in 67 cases, reforming rhomboid flap in 152 cases, nasolabial flap in 118 cses, forehead falp in 33 cases. The secondary defect of donor site was directly sutured. Results Among 428 cases, 423 cases acquired complete recovery; 3 cases which had epiderm necrosis over the far end of the flap achieved healing by the first intention and 2 cases which had suffered low-grade infection of incision achieved healing by the second intention after regional change dressings.The nasal defect was successfully repaired in all patients,and the all flaps survived. A total of 385 patients were available forfollow-up of 1 to 60 months, no tumor recurrence occurred, and the repaired tissue were good match with surrounding tissue, good nasal contour was obtained, the cosmetic results were satisfactory. Conclusion Based on the nasal aesthetic subunit principle, the local flap can reconstruct the nasal above medial defect, and a good color, contour and texture match with the surrounding skin can be obtained, the cosmetic results are satisfactory.