Eighteen cases of loss or obliteration of eye sockets from trauma or tumour were repaired with various methods: skin graft, postauricle flap with tempopostauricular blood vessel, forehead flap with temporal blood vessel and temporal flap with subcutaneous pedicle. Following 1 to 5 years follwup, the results were good and the improvement on outlooking was remarkable. The skin grafting was a simple and applicable method but it needed a longer time of blepharorrhaphy. The flap transfer was more complicated but suitable for the obliteration of the eye socket accompanied with depression deformity, but it usually would result in a secondary cicatricical malformation at the region around the eye. Thus, it was important to select a best operative method according to the specific condition.
OBJECTIVE: To explore an effective method to repair the abdominal wall defect. METHODS: From July 1996 to December 2000, 7 cases with abdominal wall defect were repaired by pedicle graft of intestine seromuscular layer and skin graft, among them, intestinal fistula caused by previous injury during operation in 4 cases, abdominal wall defect caused by infection after primary fistulization of colon tumor in 2 cases, abdominal wall invaded by intestinal tumor in 1 case. Exploratory laparotomy was performed under general anesthesia, the infective and edematous tissue around abdominal wall defect was gotten rid off, and the pathologic intestine was removed. A segment of intestine with mesentery was intercepted, and the intestine along the longitudinal axis offside mesentery was cutted, the mucous layer of intestine was scraped. The intestine seromuscular layer was sutured to the margin of abdominal wall defect, and grafted by intermediate split thickness skin. RESULTS: The abdominal wall wound in 6 cases were healed by first intention, but part of grafted skin was necrosed, and it was healed by second skin graft. No intestinal anastomotic leakage was observed in all cases. Followed up 1 to 2 years, there were no abdominal hernia or abdominal internal hernia. All the cases could normally defecate. The nutriture of all cases were improved remarkably. CONCLUSION: Pedicle graft of intestine seromuscular layer is a reliable method to repair abdominal wall defect with low regional tension, abundant blood supply and high successful rate.
【Abstract】 Objective To explore the effect of early scrotal dermatoplasty on spermatogenic functional rehabilitation of testis in juvenile pigs with third degree burn wound of the scrotum. Methods Thirty healthy male Guizhou miniature pigs (weighing 10-15 kg, 2-month-old) were divided into 3 groups: control group (group A, n=10), natural healing group (group B, n=10), and dermatoplasty group (group C, n=10). In group A, the pig was not given any treatment; after third degree burn model of the scrotum was prepared, wounds were not treated in group B and the burn skin was excised and whole hypogastric pachydermia was used for dermatoplasty in group C. At 3 months and 1 year after model preparation, bilateral testis were collected from 5 pigs, respectively. HE staining was performed to observe the effects of different repair method on the morphology of spermatogenic cells and immunohistochemical staining was used to detect Survivin protein expression. Results All pigs survived to the end of the experiment and the wound healed successfully. Histological observation showed that spermatogenic cells had normal shape at all stages and mature sperms were seen in lumens in group A; the thickness of seminiferous epithelium was thinner, having one layer or two layers of spermatogenic cells in group B; the spermatogenic cells in group C were slightly more than that in group B with some spermatids; and in groups B and C, the spermatogenic cells at 1 year were more than that at 3 months. Immunohistochemistry staining showed that the Survivin protein expression in groups B and C was less than in group A, and group B was less than group C, showing significant differences at 3 months and 1 year (P lt; 0.05), but no significant difference between 3 months and 1 year in the same group (P gt; 0.05). Conclusion Dermatoplasty has inhibitory effect on spermatogenic functional rehabilitation of testis. Dermatoplasty can decrease spermatogenic cells and reduce Survivin protein expression, but some spermatids still survive in seminiferous tubule.
目的 探討面部燒傷后肉芽創面移植自體大張中厚皮的可行性。 方法 回顧性分析2002年1月－2012年4月收治的27例面部燒傷后肉芽創面進行自體大張中厚皮移植手術患者的臨床資料。術中用手術刀刮除肉芽組織至基底層，用取皮鼓或電動取皮刀取患者大腿或者腹部大張中厚皮，移植于受皮區，術后5 d左右打開敷料半暴露或暴露。 結果 27例手術患者中24例大張中厚皮全部成活，3例大部分成活，再次補植皮后愈合。患者創面愈合后外形豐滿，皮膚彈性較好，表情豐富。20例隨訪1～5年，患者面部外觀良好，2例發生小口畸形，2例眼瞼輕中度外翻，分別行整形手術后改善。 結論 面部燒傷后肉芽創面移植大張中厚皮可獲得較滿意的治療效果，可在臨床推廣使用。
Objective To detect the expression of melanocortin 1 receptor (MC-1R) and the melanin contents in human skin autografts and the normal skin, to elucide the role of MC-1R in hyperpigmented process of skin autografts. Methods Skin autografts and normal skin samples were obtained from skin graft on neck who need reoperation to release contractures after 1 year of operations. Immunohistochemical technique was performed to detect the expression and distribution of MC-1R in skin autografts(include full thickenss skin autografts, medium thickness skin autografts, and razorthin skin autografts) and normal skin respectively. MassonFontana staining technique was performedto detect the melanin contents in all sorts specimens respectively. Results The expression of MC-1R was located on cell membrane and cytoplasm of melanocyte and keratinocyte in epidermal. The expression of MC-1R in most skin autografts was much ber than that of control normal skins; the thinnerskin autografts were, the more obvious expressions of MC-1R in skin autografts were. The expressions of MC-1R in all sorts of skinautografts were of significant differences compared with that in normal skins(P＜0.01); the expression of MC-1R in normal skin of donor area was no significant differences compared with normal skin around recipient area(P＞0.01). The contents of melanin in skin autografts were increased obviously and there were significantdifferences compared with that in normal skins(P＜0.01); the contents of melanin among all sorts of skin autografts were of significant differences (P＜0.01). The thinner skin autografts were, the more melanin contents in skin autografts. The expression of MC-1R was positively correlated with the contents ofmelanin in epidermis. Conclusion The expression of MC-1R in skin autografts is significantly higher than that in normal skin and is correlated positively with the contents of melanin in skin autografts. Overexpression of MC-1R may play an important role in hyperpigmented process of skin autografts.
ObjectiveTo study the treatment results of the pre-expanded flaps for scar contracture on face, neck, and joints by comparing with the skin grafts. MethodsA total of 240 cases of scar contracture between July 2004 and June 2014 were included in the study by random sampling; skin grafts were used in 120 cases (skin graft group), and preexpanded flaps in 120 cases (pre-expanded flap group). There was no significant difference in age, sex, injury sites, and disease duration between 2 groups (P>0.05). Re-operation rate and A&F 0-6 quantization score were used to evaluate the treatment results. ResultsThe patients were followed up 12 to 75 months (mean, 23.47 months) in the skin graft group, and 12 to 61 months (mean, 19.62 months) in the pre-expanded flap group. The re-operation rate of the skin graft group was 72.5% (87/120), and was significantly higher than that of the pre-expanded flap group (19.2%, 23/120) (P=0.000). The re-operation rate of the neck contracture in teenagers was the highest. It was 93.9% in the skin graft group and 35.0% in the pre-expanded flap group. In the patients who did not undergo re-operations, A&F 0-6 quantization score of the skin graft group was 2.85±1.12, and was significantly lower than that of the pre-expanded flap group (5.22±0.74) (t=13.830, P=0.000). ConclusionPre-expanded flap for scar contracture on face, neck, and joints has lower re-operation rate and better aesthetic and functional restoration than skin graft. It should be regarded as the preferred method for teenagers.
【Abstract】 Objective To investigate the effects of different surgical methods in treating scalp mal ignanttumors. Methods From January 1995 to September 2004, 70 patients with scalp mal ignant tumor were treated with different surgical methods. There were 41 males and 29 females with an average age of 50.3 years (30-85 years). The course of disease ranged from 2 weeks to 3 years(mean 3.5 months). There were 31 cases of basal cell carcinoma, 24 cases of squamous carcinoma, 8 cases of melanocarcinoma, 4 cases of fibrous sarcoma, 2 cases of l iposarcoma, and 1 case of vasculosarcoma. Leision size ranged from 1.0 cm × 0.5 cm to 10.0 cm × 8.0 cm. Scalp defect ranged from 3 cm × 3 cm to 12 cm × 11 cm after clearing up the tumors. Defect was repaired with free skin transplantation in 51 cases, scalp flap in 12 cases, cervico-shoulder flap in 2 cases, trapizius myocutaneous flap in 3 cases, and radial artery retro-island flap in 2 cases. The flap sizes ranged from 5 cm × 4 cm to 18 cm × 12 cm. Results Of 70 cases, 67 skin flaps survived and incision healed by first intention; 2 flaps necrosed at distal part(lt; 1 cm) and healed by second intention after dressing change; 1 flap infected and was treated with symptomatic medication.All the donor sites healed by first intention. Fifty-five patients were followed up for 1 to 5 years and 5 cases had tumor recurrence. In patients receiving skin transplantation, 1 case of squamous carcinoma and 1 case of fibrous sarcoma relapsed after 1 year and 2.5 years respectively and were given radical resection and skin flap grafting; in patients receiving skin flap grafting, 1 case of vasculosarcoma and 1 case of squamous carcinoma relapsed after 6 months and 3 months respectively, and gave up treatment; 1 case of fibrous sarcoma relapsed after 2 years and was given radical resection and skin flap grafting. The other cases survived and had no tumor recurrence. Conclusion Scalp mal ignant tumors should be diagnosised and treated as early as possible. Clearing up completely by surgery is an effective method.