OBJECTIVE: To evaluate the application of skin and soft tissue expansion in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound. METHODS: From 1988, 83 cases of application of skin and soft tissue expansion were reported. In those patients with deformity due to severe burn of large area and with whole nasal defect, soft tissue expander was used under the forehead skin graft and venter frontalis, followed by reconstruction of nose with the expanded vascularized skin flap and carved cartilago costalis as nasal frame. In patients of severe deep electrical burned scalp and skull with fresh wound, skin and soft tissue expansion were used to repair the wound simultaneously with scalp burn alopecia, anesthetics and antibiotics injected into the extracapsular space of the expander in case of pain and infection. RESULTS: All of the cases were successfully treated with little pain and minimized infection. CONCLUSION: Skin and soft tissue expansion in a safe and reliable measure in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound.
Objective To investigate the effect of the vascular endothelial growth factor (VEGF) gene therapy, the surgical delay, and the combination of the two therapeutic approaches on the survival of the rat over-area abdominal axial skin flap. Methods In 48 male Wistar rats (weight, 400-450 g), a model of the abdominal axial skin flap supplied by the superficial epigastric blood vessel was created. The rats were randomly divided into 6 groups: Group A (the blank group), Group B (the gene-therapy-during-operation group), Group C (the gene-therapy-before-operation group), Group D (themerely-surgical-delay group), Group E (the gene-therapy-during-surgical-delay group), and Group F (the gene-therapy-aftersurgical-delay group). Seven days after operation, the survival rate of the skin flap was measured; the specimens were harvested from the skin flap for a histological investigation of themicrovessels and for an immunohistochemical staining to observe the expression of VEGF165. Results The average survival rate of the skinflap was significantly greater in each of the treated groups than in Group A (Plt;0.05); the rate was the greater in Group E (Plt;0.05), but with no statistically significant difference between the other treated groups (Pgt;0.05). The average number of the microvessels was significantly greater in Groups B, C, E andF than in Groups A and D (Plt;0.05), but with no statistically significant difference between Groups B, C, E and F and between Groups A and D (Pgt;0.05). The lumen diameter of the microvessels was significantly greater in Group D than in Groups E and F (Plt;0.05), and the diameter was significantly greater in Groups D, E andF than in the other groups (Plt;0.05). More deposition of VEGF DNA detected by the immunohistochemical staining was in Groups B, C, E and F than in Groups A and D. There was no newly-formed blood vessel in the rat cornea in the treated groups.Conclusion Both the administration of pcDNA4-VEGF165 and the surgical delay can improve the survival of the rat abdominal axial skin flap, but the mechanism of the effect is different in explanation. The combination of the two therapeutic approaches can achieve a better effect.
Objective To study the effect of various doses of estrogen on tissue injury, blood supply and survival area of skin flap and to investigate its mechanism. Methods Thirty New Zealand white rabbits aged 3-4 months old and weighing 1.5-2.2 kg (male or female) were used. Random pattern skin flap (12 cm × 3 cm in size) taking the central l ine of the rabbit dorsum as axis and with the pedicle attached at the proximal end was prepared, and the flap pedicle division was performed 7 days after operation. The rabbits were divided randomly into three groups (n=10 rabbits per group). At 2, 4, and 6 days after operation, the proximal edge of flap in group A and B received 100 ?g/kg and 50 ?g/kg subcutaneous injection ofestradiol benzoate, respectively, while group C received no further treatment serving as control group. General condition ofthe rabbits was observed after injection, gross observation was performed 3 and 7 days after injection, survival area of the skin flap was measured 7 days after injection, contents of malondialdehyde (MDA) and nitric oxide (NO) were tested 5 days after injection, and the flaps were harvested 4 and 7 days after injection to receive histology and no significant difference was noted between group A and group B (P gt; 0.05). The NEU counts 4 days after injection were (18.20 ±6.24) cells/HP in group A, (21.27 ± 5.34) cells/HP in group B, and (28.78 ± 7.92) cells/HP in group C, and at 7 days after injection, there were (15.16 ± 7.02) cells/HP in group A, (18.12 ± 6.44) cells/HP in group B, and (29.67 ± 9.12) cells/HP in group C. The VEGF score 4 days after injection was (4.02 ± 0.48) points in group A, (4.19 ± 0.66) points in group B and (3.67 ± 0.49) points in group C, and at 7 day after injection, it was (4.96 ± 0.69) points in group A, (5.12 ± 0.77) points in group B, and (3.81 ± 0.54) points in group C. Significant difference was evident between 4 days and 7 days after injection in group A or B in terms of NEU counts and VEGF score (P lt; 0.05), and difference between 4 days and 7 days after injection in group C was not significant (P gt; 0.05), and the differences among 3 groups were significant (P lt; 0.05). Conclusion Estrogen injection can increase VEGF expression and NO content of flap, decrease MDA content and NEU infiltration of flat, and improve survival area of flap.
To introduce the experience and comprehend of appl ication of many kinds of skin flaps in repair of heel skin and soft tissue defect. Methods From August 1993 to April 2007, 242 cases of skin and soft tissue defect on heel were treated. There were 157 males and 85 females aged 27-76 years. There were 35 cases of unstable scar, 46 cases ofchronic ulcer, 57 cases of squamous cell carcinoma, 72 cases of mal ignant melanoma and 32 cases of injury. The defect area ranged from 2 cm × 2 cm to 8 cm × 14 cm, wound was with low-grade infection in 51 cases. The course of disease was 1 hour to 5 years. The lateral calcaneal flaps (34 cases), the dorsum pedis flaps (15 cases), the medial plantar artery island flaps (108 cases), the sural neurovascular flaps (36 cases), the saphenous neurocutaneous vascular flaps (26 cases) and free (myocutaneous) skin flaps (23 cases) were used to repair heel wounded surface according to specific location of heel wounded surface, range of skin and soft tissue defect. The size of the (myocutaneous) skin flap was 3.0 cm × 2.5 cm to 15.0 cm × 9.0 cm. The donor area was directly sutured or covered with skin grafts. Results In 242 cases, 235 cases achieved heal ing by first intention, 5 cases had partial necrosis of flaps, 2 cases had mild infection. The donor area healed by first intention. A total of 217 patients were followed up for 1 month to 60 months. The color of flaps were normal and the texture of flaps were softer than that of normal heel tissue; the flaps were wearable, the shape of flaps were satisfactory. The patients can walk after 6 months of operation, andthe gait was normal. In 118 cancer patients, no local tumor recurrence occurred, and distant metastatic lesions were observe in 22 mal ignant melanoma patients. In 32 cases of mal ignant melanoma followed up 60 months, no distant metastatic lesions were found. Conclusion In base of following the primary disease treatment, heel function reconstruction and contour structural feature remodel ing, we adopted some kind of island or free (myocutaneous) skin flap can be used to repair heel wound. The ideal effect in heel function reconstruction and contour structural feature remodel ing were obtained.
The applied anatomy and clinical application were described in this paper. The blood supply of this flap was based on the second dorsal metacarpal artery. It gave some advantages of as easy of application, safe and reliable. Since November 1990, we had successfully used six such flaps in covering the soft tissue defects of the hand.
In order to observe the effect of far infrared rays on the survival of skin flap, the following experiment was performed. Forty-eight SD rats were selected and divided into two groups. The rats received 0.3 w/cm2 radiation twice a day from 3 days before operation to 5 days after operation in the experimental group, while in the control group the rats received none before or after the operation. The flap was designed as 2 cm x 6 cm in the back of the rats with the pedicle caudalward. The microcirculatory changes of the flap were observed, and the survival area of the flap was calculated. The results showed that either in the proximal or in the distal part of the graft, in the experimental group, the mean opening rate, diameter and the flowing velocity of the microvessels were significantly higher than those in the control group (P lt; 0. 05). The mean rate of survival area of the experimental group (80.5%) was also higher than that of the control group (62.7%) (P lt; 0.01). It was suggested that radiation with far infrared rays could dilate the microvessels, improve the flap microcirculation, therefore, enhance the survival of the randomized skin flap.
In this study, 8 pigs, weight ranged from 25 to 30kg, were used. Island skin flaps with the deep circumflex iliac artery were designed as pedicle on both buttocks. In the distal half of the island skin flap, which had been made on the right buttock, a subdermal vascular network island skin flap was made by preserving the subdermal vascular network. Blood supply between the two types of skin flap was compared by skin temperature, laser Doppler, fluorescent stain, histological examination, ink perfusion microangiography and transparent specimen technique. The observation showed thatthe blood supply of the subdermal vascular network island skin flap was decreased prominently in comparison with that of the conventional island skin flap. The subdermal vascular network skin flap was actually a combination of axial pattern skin flap with randomized skin flap.
In order to study the effect of vascular endothelial cell growth factor (VEGF) on the survival of skin flap 30 SD rats were used. A randomized flap measuring 7.5 cm x 3.0 cm was created on the back of each SD rat. The treatment group (n = 10) received VEGF 40 ng/flap by subcutaneous injection with microinjector during and 24 hours after operation. The control groups received heparin 16 U/flap (n = 10) or normal saline 800 microliters/flap (n = 10). After operation, on the 3rd and 11th day, the survival rate of the skin flaps and the dermovascular density of each flap were investigated by histological and histo-morphometrical examination. The results showed that there was no significant difference in the survival rate between the treatment group and the controls on the 3rd day after operation, while on the 11th day, there was a significant difference between them, and the survival rate was much higher in the treatment group. Besides, dermovascular density was much more increased in the treatment group than that in the controls, especially in the distal 1/3 of the flap (P lt; 0.02). The conclusion was that VEGF could .
Through observation on the cast and perfused humen specimens, it was found that in some donor areas of skin flap the veins run loosely in compare with their arteris. The companionship of the axial artery and vein can be divided into 3 types: (1)One set of venous system, which runs loosely in company with the artery, such as the pedicle vessels in flaps of head and face areas; (2)Two sets of accompaned venous system, one of them did not accompany closely with the axial artery, as is the vessel in skin flaps of low abdominal areas; (3) Lack of accompanying venous system, as is found in the dorsal finger flaps. Based on these anatomical companionships of the veins with their arteries, when such flaps as mentioned above are adapted, it is preferable to take abroadened fascial pedicle in order to achieve a higher survival rate of skin flap transplantation.
The canine saphaneous skin flap was used as a model in this experiment. The cutaneous autograft would give long-term survival, whereas the allograft without pretreatment would only survive 10. 2±1.9 days from its transplantation. If the pretreatment consisted of the use of immunosuppressive agent as PHA or infusion of dexamesone, the survival days of the allografts could be prolonged to 15.1±2.5 and 13.7±2.8, respectively(Plt;0.01). The histological examination gave the evidence that drug perfusion delayed the rejection.