Objective To introduce the application of the scrotal flap on reconstructing partial urethra defect. Methods From March 1998 to August 2004, 31 patients with urethra defect were treated with scrotal flap. Their ages ranged from6 to 34 years. Thirty-one patients included 8 cases of congenital deformity of urethra and 23 cases of complication of urethral fistula, urethral stenosis and phallus bend after hypospadias repair. The flap widths were 1. 2. cm in child and 2.3. cm in adult. The flap lengthwas 1. -2.0 times as much as the width. Nine cases were classified as penile type, 10 cases as penoscrotal type, 7 cases as scrotal type(3 children in association withcleft scrotum) and -cases as perrineal type because of pseudohermaphroditism.Urethroplasty was given by scrotal fascia vascular net flap to reconstruct urethra defect. Results All the flaps survived, and the incision healed well. Twenty four cases achieved healing by first intention and 7 cases by second intention. And fistula occurred and healed after 2 weeks in 1 case. 27 cases were followed up 14 years, 2 cases had slight chordee, the others were satisfactivly. Conclusion Urethroplasty with scrotal fascia vascular net flap is an ideal method for the partial defect urethra.
One hundred and twenty-eight cases of peripheral aneurysm were reported.Traumatic prsucdoaneursyms(87cases)dominated and aneurysm in lower extremities(68 cases)consisted of most the cases.Rupture of aneurysm and massive kaemomhage is the most serious complications(22 cases in the report).Therefore,operative treatment should be performed soon after the diagnosis is ascertained.Resteration of normal blood flow should be the aim.Intracystic repairation is indicated in pseudoaneurysm with part of the vascular wall invaded.Artificial graft may be indicated for aneurysm of the middle and large artery,and autovenous graft for the smaler arteries.Aneurysm may be resected if the procedure is easy to perform or there is severe inflammation around the aneurysm.Proper postoperative drainage is important.General heparinization during blockade of local circulation is also important in case of vascular grafting. We concluded that proper selection of operative procedure is essential for better prognosis.
Objective To investigate the feasibil ity of building the 3D reconstruction of short segment common peroneal nerve functional fascicles based on serial histological sections and computer technology. Methods Five cm of the common peroneal nerve in the popl iteal fossa, donated by an adult, was made into the serial transverse freezing sections(n=200) at an interval of 0.25 mm and 10 μm in thickness per section. Acetylchol inesterase staining was adopted and the nerve fascicles were observed by microscope. 2D panorama images were acquired by high-resolution digital camera under microscope (× 100) and mosaic software. Different functional fascicles were distinguished and marked on each section. The topographic database was matched by image processing software. The 3D microstructure of the fascicular groups of 5 cm common peroneal nerve was reconstructed using Amira 3.1 3D reconstruction software. Results Based on microanatomy and the results of acetylchol inesterase staining, this segmented common peroneal nerve functional fascicles was divided into sensory tract, motor tract, mixed tract and motor-predominating mixed tract. The cross merging was not evident in the nerve fascicles between deep peroneal nerve and superficial peroneal nerve, but existed within the functional fascicles of the deep peroneal nerve and the superficial peroneal nerve. The results of 3D reconstruction reflected the 3D structure of peripheral nerve and its interior functional fascicles factually, which displayed solely or in combination at arbitrary angles. Conclusion Based on serial histological sections and computer technology, the 3D microstructure of short-segment peripheral nerve functional fascicles can be reconstructed satisfactorily, indicating the feasibil ity of building 3D reconstruction of long-segmental peripheral nerve functional fascicles.
To provide anatomical evidences for the blood supply compound flap based on fibular head to rebuild internal malleolus. Methods The morphology of vessels and bones in donor site and in recipient site was observed. The materials for the study were l isted as follows: ① Forty desiccative adult tibias (20 left and 20 right respectively) were used to measure the basilar width, middle thickness, anterior length, posterior length and introversion angle of internal malleolus; ② Forty desiccative adult fibulas (20 left and 20 right respectively) were used to measure the middle width and thickness, as well as the extraversion angle of articular surface of fibular head; ③ Thirty adult lower l imb specimens which perfused with red rubber were used to observe the blood supply relationships between the anterior tibial recurrent vessels and fibular head, and internal anterior malleolar vessels inside recipient site. Results The internal malleolus had a basilar width of (2.6 ± 0.2) cm, a middle thickness of (1.3 ± 0.2) cm, an anterior length of (1.4 ± 1.9) cm and a posterior length of (0.6 ± 0.1) cm. Its articular facet was half-moon. Its introversion angle was (11.89 ± 3.60)°. The fibular head had a middle thickness of (1.8 ± 0.6) cm, a middle width of (2.7 ± 0.4) cm. Its articular facet was toroid, superficial and cavate in shape, and exposed inwardsly and upwardsly, and had a extraversion angel of (39.2 ± 1.3)°. The anterior tibial recurrent artery directly began from anterior tibial artery, accounting for 93.3%. Its initiation point was (4.5 ± 0.7) cm inferior to apex of fibular head. Its main trunk ran through the deep surface of anterior tibial muscle, and ran forwards, outwards and upwards with sticking to the lateral surface of proximal tibia. Its main trunk had a length of (0.5 ±0.2) cm and a outer diameter of (2.0 ± 0.4) mm. Its accompanying veins, which had outer diameters of (2.1 ± 0.5) mm and (2.6 ± 0.4) mm, entry into anterior tibial vein. It constantly gave 1-2 fibular head branches which had a outer diameter of (1.7 ± 1.3) mm at (1.0 ± 0.4) cm from the initiation point. The internal anterior malleolar artery which began from anterior tibial artery or dorsal pedal artery had a outer diameter of (1.6 ± 0.4) mm. Its accompanying veins had outer diameters of (1.3 ± 0.5) mm and (1.1 ± 0.4) mm. Conclusion The blood supply compound flap based on fibular head had a possibil ity to rebuild internal malleolus. Its articular facet was characterized as the important anatomical basis to rebuild internal malleolus.
Objective To describe the characteristics of short arm deformity in patients with achondroplasia, and summarize the progress of its lenthening and reconstruction, so as to provide reference for clinical diagnosis and treatment. MethodsThe literature on the lenthening of upper limb with achondroplastic short arm deformity at home and abroad in recent years was reviewed, and the characteristics, extension methods, postoperative management, effectiveness evaluation, and related complications of short arm deformity were summarized. Results Achondroplastic short arm deformity affect the patient’s daily perineal hygiene activities. Although the upper limb is proportionately shortened, the humerus is mainly short limb deformity. Bilateral humeral lengthening is a common treatment method, and the traditional lengthening tools are mainly external fixation, guided by Ilizarov distraction osteogenesis concept; intramedullary lengthening is the latest treatment method. Lengthening percentage and healing index are commonly used for clinical evaluation indexes, and complications such as nerve injury may occur during upper limb lengthening. Conclusion In addition to appearance improvement, achondroplastic short arm lengthening is of great significance in achieving self-management of individual perineal hygiene. Lenthening and reconstruction methods are constantly being innovated and improved.
Objective To review the progress in clinical and biomechanical study on soft tissue reconstruction of adult-acquired flatfoot deformity (AAFD). Methods The recent original articles of soft tissue repair and tendon transfer for AAFD were extensively reviewed. Results The soft tissue procedures for AAFD can be divided into two components: static restoration of medial column stability and dynamic reconstruction of the posterior tibial tendon. The most important static structure to be repaired for AAFD is the spring ligament. On the other hand, various methods can be used for dynamic reconstruction. The flexor digitorum longus transfer is widely used, but results of biomechanical studies do not support the advantage of this method. For patients having normal function of the posterior tibial muscle, the Cobb procedure may be more suitable. Conclusion The soft tissue reconstruction procedures of AAFD should be chosen individually based on the stage and type of the deformity.
Objective To establ ish sophisticated three-dimensional finite element model of reconstructing the whole pelvis and defects in pelvis caused by the resection of periacetabular tumor, and to research the stress distribution regularity ofthe pelvis reconstructed by the fibular transplantation through three different internal fixation techniques. Methods The CTdatasets including L3 to middle-femur, unilateral fibular and internal fixation system from 1 healthy 35-year-old male volunteer were collected to establ ish finite element models of reconstructing the pelvis after the resection of periacetabular tumors through 3 different internal fixation means, namely fibular with plates, pedicle-rods and sacral-il iac rods. Bilateral leg standing position was simulated, then vertical load of 500 N was imposed on the surface of L3, the stress distribution regularity of reconstructed pelvis, transplanted fibular and internal fixation system were evaluated. Results The finite element models of the pelvis reconstruction after resection of periacetabular tumors were establ ished. The stress concentration of transplanted fibular was extremely high in the vicinity of the host junction sites. For the three internal fixation systems, the connection between steel plate and screw or between titanium bar and screw inclined to have stress concentration; and when the titanium bar was adopted to reconstruct, the transplanted fibular and the healthy side of femoral neck had less stress concentration, while sacral-il iac rods had the most obvious stress concentration. Conclusion For the reconstruction pelvis, the three fibula transplantation and steel plate internal fixation are consistent with intact state of pelvis in terms of the stress distribution, which is a relatively good method for the treatment of bone defect after periacetabular tumor. The finite element model can be used as a tool for the pelvis biomechanics research.
【Abstract】 Objective To discuss the aesthetic effect and appl ication of refined incisions in breast reconstructionfor breast cancer patients by the transverse rectus abdominis myocutaneous (TRAM) flap. Methods From January 2001 toOctober 2006, 77 cases with breast cancer were treated with TRAM flap to immediate breast recontruction. The patients were all femals, with an average age of 45 years (ranging from 26 years to 53 years). There were 39 cases of left breast and 38 cases of right breast. The disease course was from 1 day to 180 days. There were 11 cases of stage I , 60 cases of stage II and 6 cases of stage III, among which 34 cases were located in the upper outer quadrant, 15 in the lower outer quadrant, 22 in the upper inner quadrant and 6 in the lower inner quadrant. The size of tumors varied from 1 cm to 4 cm. As to the pathologic type, 60 cases were invasive ductal cancers, 12 ductal cancers in situ, 5 invasive lobular cancers; positive lymph node (number: 1-7) happened in 29 cases, while negative lymph node happened in 48 cases. Among the 77 cases, regular shuttle incisions were performed in 35 cases, and refined circle incisions were performed in 42 cases, which were 2 cm away from the breast tumor border. Axillary incision was necessary for the breast tumors located in upper inner, lower inner and upper outer quadrants in order to perform axillary mastectomy. Ten cases were ni pple-areola sparing. The shape, symmetry and incision scar of the reconstructed breast were evaluated and graded. Results There were 6 cases out of 77 cases of breast reconstruction in which partial necrosis happened and the necrosis rate was 7.79%. The time of follow-up was from 13 months to72 months, with an average of 39 months. No recurrence or matastasis happened in 76 cases, and distant metastasis happened only in 1 case. There were 40 cases out of 42 cases with refined incisions which were scored more than 3, and the satisfaction rate was 95.24%. There were 31 cases out of 35 cases with regular incisions which were scored more than 3, and the satisfaction rate was 88.57%. Conclusion The reasonable refined incision based on the location of the tumor is effective to improve the satisfaction rate for the shape of the reconstructed breast.
ObjectiveTo explore the effectiveness of functional reconstruction of hand grasp and pinch by tendon transfers in patients with cervical spinal cord injury.MethodsBetween July 2013 and January 2016, tendon transfer surgery were performed in 21 patients (41 hands) with cervical spinal injury that motion level was located at C6 to reconstruct hand grasp and pinch function. There were 18 males and 3 females with a mean age of 42.3 years (range, 17-65 years). Nineteen patients were with complete spinal cord injury [American Spinal Injury Association (ASIA) grading A], 1 patient was with central cord syndrome whose bilateral hands were completely paralyzed and lower limbs were normal (ASIA grading D), and 1 patient was with cervical spondylotic myelopathy (AISA grading D). The time from injury to hospitalization was 12-22 months (mean, 16.8 months). According to the International classification of surgery of the hand in tetraplegia (ICSHT), there were 6 cases of grade O3, 10 of grade O4, 3 of grade OCu5, and 2 of grade O5. The surgery was divided into two stages with an interval of 6-11 months. At the first stage, grip function was reconstructed in all patients by transfering the extensor carpi radialis longus from radialis side to palmar side through subcutaneous tunnel, and braided and sutured with the flexor pollicis longus and flexor digitorum profundus. At the second stage, the lateral pinch function of the thumb and index finger was reconstructed by braiding and suturing the radial half of the extensor carpi ulnaris (the patients graded as ICSHT O3) or pronator tere (the patients graded above ICSHT O3) with extensor pollicis longus and abductor pollicis longus. The grasp force, the thumb and index finger lateral pinch force, and the maximum fingertips distance between the thumb and index finger were measured at preoperation and at different time points after operation. The modified Lamb and Chan questionnaire, based upon the activities of daily living, was used to evaluate the hand function of all patients at 6 months after sencond stage surgery.ResultsThere was 1 patient with elbow skin lesion, 1 patient with wrist stiffness; both of them recovered after corresponding treatment. All the 21 patients were followed up 15-32 months (mean, 19.6 months) without wound infection, tendon adhesion, tendon rupture, and other complications. The grasp forces of all patients were significantly improved at 4 weeks, 3 months, 6 months, and 1 year after the first stage surgery when compared with preoperative value (P<0.05); and no significant difference was found between different time points after operation (P>0.05). The thumb and index finger lateral pinch force and the maximum fingertips distance between the thumb and index finger of all patients were also significantly improved at 4 weeks, 3 months, 6 months, and 1 year after the second stage surgery when compared with preoperative values (P<0.05); and no significant difference was found between different time points after operation (P>0.05). And there was no significant difference of above indexes between the patients graded as ICSHT O3 and above ICSHT O3 (P>0.05). The functional outcome was good in 19 cases, fair in 1 case, and poor in 1 case according to modified Lamb and Chan questionnaire at 6 months after second stage surgery.ConclusionTendon transfer can significantly improve the hand function and the quality of life of the patients with complete cervical spinal cord injury.
The study aimed to evaluate the safety and function of poly(lactic-acid-co-ε-caprolactone) (PLCL)/fibrinogen nanofibers (P/F-Ns), and provide theoretical basis for the clinical application. The surface morphology, mechanical properties, the hydrophilicity and the fibrinogen content of P/F-Ns were tested by scanning electron microscope, the material testing machine, the contact angle meter and the microplate reader, respectively. The cell adhesion, proliferation and ligament remodeling genes expression of Hig-82 cells on P/F-Ns were conducted through cell counting kit-8 (CCK-8) and real-time quantitative PCR analyses, respectively. The results showed that with the increase of the fibrinogen content, the pore sizes and hydrophilicity of three P/F-Ns increased, but the mechanical properties decreased. Cell adhesion and proliferation tests showed that P/F-N-2 held the best ability to promote cell adhesion and proliferation. The ligament remodeling genes expressions of Hig-82 cells on P/F-N-1, P/F-N-2 and P/F-N-3 were all up-regulated compared to P/F-N-0 on days 3 and 7. All the three P/F-Ns containing fibrinogen (P/F-N-1, P/F-N-2 and P/F-N-3) had better biocompatibility compared to P/F-N-0, and could be efficiently applied to the reconstruction of anterior cruciate ligament.