Objective To study the surgical treatment of tracheal and main bronchial tumors. Methods We retrospectively analyzed the clinical data of 30 patients with tracheal and main bronchial tumors treated in Shengjing Hospital of China Medical University from January 2000 to December 2015. There were 12 males and 18 females with the age ranging from 22 to 80 years. Results Ten patients were treated with enucleation, 12 patients tracheal tumor resection and end-to-end anastomosis, 1 patient window resection, 1 patient wedge resection, 5 patients tumor resection and tracheal reconstruction by using pulmonary tissue flap with alloy stent and 1 patient left pneumonectomy. One patient died of sudden massive hemoptysis 26 d after operation. Intraoperative complications were found in 2 patients. Others had a good recovery after operation. Patients were followed up for 11 months to 14 years. Eight patients were followed up less than 5 years postoperatively, one patient died of sudden massive hemoptysis 14 months after operation, while others survived; 21 patients were followed up more than 5 years and 5 patients were lost to follow-up. Conclusion Surgical resection is recommended for tracheal and main bronchial tumors. Patients with small benign tumor may choose local tracheal resection; tracheal segmental resection and end-to-end anastomosis is the most common surgical treatment. Patients with more than half of the whole length of tracheal defects or in the risk of anastomotic ischemic necrosis may be suggested to receive tracheal reconstruction.
Objective To summarize and review the development and experience of anastomosis vascular pedicle free composite tissue flap. Methods From July 1987 to March 2007， 321 patients with complete records were treated. Fourteen tissue flaps were applied for the repair of trauma or tumor excision defects of the body, and for organ reconstruction. Results Vascular crisis occurred in 20 patients within 48 hours postoperatively. Necrosis occurred at flap end in 6 patients. The total survival rate was 94.8%. The main experience was: ① Training to grasp the basic microvascular anastomosis technique was very importantstarting up period for surgeons. The basic technique should be often practiced to ensure the safty of clinical application. ②Restoring appearance and function were equally important in practice.③Utilizing the minimal invasive methods and decreasing the loss of function of donor site were important for improvement of reconstruction quality. The purpose was to achieve functional and esthetic restoration in the condition of lowest donor site scarification. Conclusion The application of free composite tissue flap is important for the development of plastic surgery. There are extensive applications for free flap, especially for those critical patients. The application of free flap could decrease the mobility rate, shorten the treatment period, ease the pain of patients and improve the reconstruction effect. The experience of donor site selection, the strategy of poor recipient site condition, the advantages and disadvantages of muscle flap, the applications time, infections wound treatment and application, are helpful for the future application.
Objective-To apply self-pulmonary tissue flap to reconstruct esophagus directly or with alloy stent in this research. Methods Twenty-four dogs were divided into two groups, middle bronchus was ligated to prepare pulmonaryflap and incised, a 4 to 6 cm long and 1/2 to 2/3 perimeter defect was made in esophageal wall. Esophagus defect was repaired only with pulmonary flap (experimental group) and with pulmonary flap having self-expanded stent inside (control group). The gross appearance, histological apearance and barium X-ray films were observed at 2,4,6,8,10 and 12 weeks after operation. Results Two dogs died of anatomotic leak in experimental group, three dogs died of anatomotic leak and two dogs died of perforation of ulcer in control group. The growth of esophagus epithelium was observed from periphery area to central area after 8 to 10 weeks of operation. In pulmonary flap mass fibrous tissue proliferated and fibroblasts were active, but no necrosis occurred. Barium X-ray ofregenerated esophagus showed that mild stenosis and weakened peristalisis were observed in the middle of resophagus replacement, and that no obstruction, leakage, and dilation above anastomotic stoma occurred. Conclusion Pulmonary tissue flap can well support the mucosa crawl in the defect of esophagus. It is necessary to find a more suitable and satisfied stent for repairing segmental defect.
Objective To report 4 methods of reconstructing soft tissue defects in oral and maxillofacial regions after tumors resection using cervical pedicle tissue flaps. Methods One hundred seventy-two soft tissue defects were repaired with cervical myocutaneous flaps after resection of oral and facial cancer( 165 cases of squamous cell carcinoma and 7 cases of salivary carcinoma). The clinical stage of the tumors was stage Ⅰ in 21 cases, stage Ⅱ in 116 cases and stage Ⅲin 35 cases. Primary sites of the lesions were the tongue (59 cases), buccal mucosa (55 cases), lower gingiva (26 cases), floor of the mouth (25 cases), parotid gland (4 cases) and oropharynx (3 cases). Infrahyoid myocutaneous flaps were used in 60 cases, platysma flaps in 45 cases, sternocleidomastoid flaps in 59 cases and submental island flaps in 8 cases. The sizes of skin paddle ranged from 2.5 cm×5.0 cm to 5.0 cm ×8.0 cm. Results Among 153 survival flaps, there were55 infrahyoid myocutaneous flaps, 40 platysma flaps, 52 sternocleidomastoid flaps and 6 submental island flaps. There were 11 cases of total flap necrosis and8 cases of partial flap necrosis. The success rates were 91.67%(55/60) for infrahyoid myocutaneous flap, 88.89%(40/45) for platysma flap, 88.14% (52/59) for sternocleidomastoid flap and 75%(6/8) for submental island flap. After a follow-up of 3 11 years(5.7 years on average) among 101 cases local reccurence in 18 cases, cervical reccurence in 4 cases, distance metastasis in 2 cases. The survical rate at 3 years were 83.17%(84/101). Conclusion Cervical pedicle tissue flaps haveclinical value in reconstruction of small and medium-sized soft tissue defects after resection of oral and maxillofacial tumors.
ObjectiveTo explore a new improved technique and its effectiveness to repair dorsal thumb composite tissue defects including interphalangeal joint by transplantation of modified hallux toe-nail composite tissue flap. MethodsThe hallux toe-nail composite tissue flap carrying distal half hallux proximal phalanx, extensor hallucis longus, and interphalangeal joint capsule were designed and applied to repair the dorsal skin, nails, and interphalangeal joint defect of thumb in 14 cases between January 2007 and June 2013. They were all males, aged from 19 to 52 years (mean, 30 years). The time from injury to hospital was 0.5-2.0 hours (mean, 1.2 hours). The area of the thumb nail and dorsal skin defects ranged from 2.5 cm×1.5 cm to 5.0 cm×2.5 cm. The dorsal interphalangeal joint had different degrees of bone defect, with residual bone and joint capsule at the palm side. The length of bone defect ranged from 2.5 to 4.0 cm (mean, 3.4 cm). The hallux nail flap size ranged from 3.0 cm×2.0 cm to 6.0 cm×3.0 cm. The donor sites were repaired by skin grafting in 5 cases, and retrograde second dorsal metatarsal artery island flap in 9 cases. ResultsAfter operation, arterial crisis occurred in 1 case and the flap survived after relieving pressure; the other flaps survived, and wounds healed by first intention. Liquefaction necrosis of the skin grafting at donor site occurred in 3 cases, and the other skin grafting and all retrograde second dorsal metatarsal artery island flaps survived. The follow-up ranged from 9 months to 3 years and 6 months (mean, 23 months). The secondary plastic operation was performed in 4 cases at 6 months after operation because of slightly bulky composite tissue flaps. The other composite tissue flaps had good appearance, color, and texture. The growth of the nail was good in 12 cases, and slightly thickened in 2 cases. At last follow-up, X-ray examination showed that bone graft and proximal phalanx of the thumb had good bone healing in 12 cases. Good bone healing was obtained at the donor site. According to the Hand Surgical Branch of Chinese Medical Association standard for thumb and finger reconstruction function, the results were excellent in 12 cases and good in 2 cases, and the excellent and good rate was 100%. No pain at donor site was observed, with normal gait. ConclusionTransplantation of modified hallux toe-nail composite tissue flap to repair dorsal thumb composite tissue defects including interphalangeal joint can effectively improve the appearance and function of the impaired thumb.
ObjectiveTo summarize the application of adjacent tissue flap for reconstruction of partial breast defect in breast conserving surgery. MethodsThe relevant literatures in recent 5 years were reviewed, and the oncoplastic techniques, classification of the adjacent tissue flaps, were summarized. Furthermore, the indications, advantages and disadvantages of the adjacent tissue flaps were evaluated. ResultsCurrently, there were various ways to reconstruct the breast defect following breast conserving surgery. For the patient, whose breast defect volume was bigger, the application of the adjacent tissue flap was one of the effective methods to obtain better aesthetic outcomes. The adjacent tissue flaps included the following:the lateral thoracodorsal fasciocutaneous flap, thoracodorsal artery perforator flap, inframammary adipofascial flap of the anterior rectus sheath, inter-costal artery perforator flap, internal mammary artery pedicled fasciocutaneous island flap, and so on. ConclusionThe adjacent tissue flap replacement technique in breast conserving surgery for reconstruction of the breast defect is a safe and effective procedure, and patients are satisfied with breast shape and overall cosmetic outcomes for it.
ObjectiveTo systematically review the efficacy of acellular dermal matrix (ADM) and subepithelial connective tissue flap (sCTG) on patients with gingival recession (GR).MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) about the efficacy of ADM and sCTG on patients with GR from inception to August 11st, 2019. Two reviewers indepeudently screened literature, extracted data and assessed the risk of bias of included studies, and then meta-analysis was performed by using RevMan 5.3 software and Stata 12.1 software.ResultsA total of 9 RCTs were included. The results of meta-analysis showed that: there were no significant differences in probing depth (PD) (MD3m=−0.04, 95%CI −0.18 to 0.11, P=0.63; MD6m=−0.01, 95%CI −0.13 to 0.12, P=0.90) and GR degree (MD3m=−0.10, 95%CI −0.37 to 0.18, P=0.48; MD6m=−0.02, 95%CI −0.33 to 0.29, P=0.89) in 3 and 6 months after operative between two groups. But the clinical attachment loss (CAL) in 3 months after operation (MD=0.33, 95%CI 0.00 to 0.66, P=0.05) and width of keratinized tissue (KTW) in 6 months after operation (MD=−0.48, 95%CI −0.76 to −0.20, P=0.000 7) of sCTG group were superior to ADM group, the differences were statistically significant.ConclusionCurrent evidence shows that there are no differences in PD and GR degree in 3 months and 6 months after operation between ADM and sCTG group. But the CAL in 3 months after operation and KTW in 6 months after operation of sCTG group is superior to ADM group. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.
ObjectiveTo investigate the effectiveness of combined tissue transplantation for repair of serially damaged injuries on radial side of hand and function reconstruction. MethodsBetween May 2013 and May 2017, 34 cases of serially damaged injuries on radial side of hand were treated. There were 29 males and 5 females; aged 17-54 years, with an average of 32.1 years. There were 23 cases of crushing injuries, 5 cases of bruising injuries, 4 cases of machine strangulation injuries, and 2 cases of explosion injuries. The time from injury to admission was 40 minutes to 3 days, with an average of 10 hours. According to the self-determined serially damaged injuries classification standard, there were 1 case of typeⅠa, 2 cases of typeⅠb, 10 cases of typeⅡa, 5 cases of type Ⅱb, 3 cases of type Ⅱc, 1 case of type Ⅱd, 7 cases of type Ⅲa, 3 cases of type Ⅲb, 1 case of type Ⅲc, and 1 case of type Ⅲd. According to the classification results, the discarded finger, nail flap, the second toe, anterolateral thigh flap, ilium flap, fibula flap, and other tissue flaps were selected to repair hand wounds and reconstruct thumb, metacarpal bones, and fingers. ResultsAfter operation, 2 cases of flaps developed vascular crisis and survived after symptomatic treatment; the other transplanted tissue survived smoothly. All cases were followed up 1 to 7 years, with an average of 2.4 years. The average fracture healing time was 7.4 weeks (range, 5.3-9.0 weeks). At last follow-up, the reconstructed fingers and the grafted flaps recovered good sensory function, with a two-point discrimination of 5 to 11 mm (mean, 9 mm). According to the evaluation standard of the upper limb function evaluation of the Chinese Medical Association Hand Surgery Society, the reconstructed thumb was rated as excellent in 24 thumbs, good in 8 thumbs, and fair in 2 thumbs; the reconstructed finger was rated as excellent in 18 fingers, good in 2 fingers, and fair in 1 finger. ConclusionFor the serially damaged injuries on radial side of hand, according to its classification, different tissues are selected for combined transplantation repair and functional reconstruction, which can restore hand function to the greatest extent and improve the quality of life of patients.
Objective To investigate the effectiveness of tissue flap grafting and sequential bone lengthening for repairing severe soft tissue and bone defects of the lower extremity after burn injury. Methods Between January 2010 and December 2015, 11 cases of large segmental bone and soft tissue defects in the leg were treated. There were 10 males and 1 female, with a mean age of 28 years (range, 19-37 years). The causes included traffic accident in 8 cases, high voltage electric burn in 2 cases, CO poisoning burn in 1 case. The time from injury to admission was 3-14 days (mean, 6.5 days). The bone defect length was 8-18 cm (mean,14 cm); the skin soft tissue defect ranged from 13 cm × 8 cm to 25 cm × 19 cm. After complete removal of necrotic tissue and lesions of the femur or the tibia, the tissue flaps were used to repair soft tissue defect of the lower extremity in one-stage operation; bone defect was treated by Orthofix single side external fixation or Ilizarov ring external fixation in two-stage operation. Results Eleven flaps survived completely, primary healing of incision was obtained in the others except for 1 patient who had necrotic bone infection, which was cured after removing necrosed femoral bone and filling with antibiotic bone cement spacer. During bone lengthening, pin tract infection occurred in 1 patient, and infection was controlled after dressing change. Bone lengthening ranged from 8 to 18 cm, with an average of 14 cm. After prolonged extension, the external fixator was retained for 4-12 months (mean, 6.5 months). All bone defects were repaired with bone healing time of 12-22 months (mean, 17 months). All patients were followed up 8-24 months (mean, 15 months). No vascular and neurological complication occurred during operation; no osteomyelitis or re-fracture occurred after operation, and the recovery of the lower extremity function was good. Conclusion Tissue flap grafting combined with bone lengthening is an effective method to repair severe bone and soft tissue defects of lower extremity.
Objective To investigate the clinical application and effectiveness of the composite tissue flaps pedicled with perforating branch of posterior tibial artery for repairing distal leg defects. Methods Between September 2014 and August 2017, 12 patients with skin and bone defects of distal leg were repaired with the composite tissue flaps pedicled with perforating branch of posterior tibial artery. There were 8 males and 4 females with an average age of 41.3 years (range, 25-66 years). The causes of injury included traffic accident injury in 7 cases, heavy crushing injury in 2 cases, tibial osteomyelitis with soft tissue ulcer and necrosis in 2 cases, and bone and soft tissue defect after resection of bone tumor in 1 case. Eight patients underwent primary repair, and 4 patients underwent second-stage repair. The size ranged from 6 cm×4 cm to 10 cm×7 cm in skin flap, from 4.0 cm×2.5 cm to 8.0 cm×6.0 cm in muscle flap, and from 4 cm×2 cm×2 cm to 5 cm×4 cm×4 cm in tibial bone flap. Tibial defects of the donor region were repaired by autologous iliac bone grafting, and the wounds were sutured directly in 7 cases and repaired by autologous skin grafting in 5 cases. Results All composite tissue flaps survived and both the recipient and the donor wounds healed primarily. All patients were followed up 6-12 months, with an average of 10.8 months. The appearance, color, texture of the composite tissue flaps and ankle function were satisfactory. X-ray films showed that the bone flap at the tibia defect and the ilium graft at the donor site both healed well at 6 months after operation. Conclusion The composite tissue flaps pedicled with perforating branch of posterior tibial artery has abundant blood, and it is a good donor region for repairing the distal leg defects combined with circumscribed bone defect.