OBJECTIVE: To investigate the method of improving the vitality of skin graft on donor site of the great toe-nail skin flap. METHODS: From June 1982 to April 1998, 252 cases of the great toe-nail flaps with piece of phalangeal bone and 18 cases of the simple great toe-nail flap were repaired with thin skin graft and packed under proper pressure. The stitches were removed two weeks later in common situation. It should be postponed on split thickness or partial survival skin flap avoiding early mobilization. RESULTS: Sixty-six cases of skin graft were necrotic after operation. Among them, 38 cases needed second skin grafting and 28 cases were healed after changing dressing. The survival rate of skin grafting was obviously higher on phalangeal marrow surface than on periosteum of the naked phalange. Contracture of the skin graft after operation made the retained skin flap expanding from medial side to lateral side and covered the whole plantar surface of the great toe. CONCLUSION: The survival rate of the skin graft on donor foot is improved after adopting the improved measures on taking the flap from great toe and paying attention to skin graft planting and packing. Free flap grafting is advocated for repairing of the wound on donor area of the great toe nail flap.
ObjectiveTo study the development of methods assessing donor liver viability in liver transplantation.MethodsThe literature in the recent years on the methods of assessing donor liver viability was reviewed.ResultsFrom donor liver morphology to function,there have being developed many methods which assess donor liver viability,including:①donor liver appearance; ②intraoperative biopsies; ③donor liver microcirculation; ④portal pressure; ⑤enzymes levels in liver; ⑥lidocainemetabolizing activity; ⑦energy metabolism of donor liver; ⑧fat content in donor liver.ConclusionThere are many methods to assess the viability of donor liver. Each has its supericrity and defect respectively. Intraoperative biopsies, 31Pmagnetic resonance spectroscopy and portal pressure have more importance in clinical application.
Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts. Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (Pgt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.
Objective To summarize the experiences of donor heart procurement of heart transplantation so as to improve the efficiency of donor heart protection. [WTHZ]Methods [WTBZ]From April 2002 to October 2006, sixtyone patients with endstage heart disease had undergone orthotopic heart transplantation. Donors were all male brain deaths, aged from 21 to 53, and 5 of them were older than 40. There were 6 cases in which the weight difference between donor and recipient＞20%, and the rest ≤±20%. Fortyfive cases had the same ABO blood type, and 16 had matching ABO blood type. Four donor hearts were procured under the condition of stable hemodynamics and enough oxygen after brain death(typeⅠ), fortyfour donor hearts were procured under the condition of brain death with acute hemorrhage and hypovolemia (typeⅡ), and 13 donor hearts were procured under the condition of brain death with cardiac arrest (typeⅢ). Twenty cases underwent standard transplantation procedure, one underwent total heart transplantation procedure and 40 underwent bicaval transplantation procedure. The donor heart cold ischemic period ranged from 52 to 347 min（92±31 min）, and 13 cases were more than 240 min. Results Two cases died of low cardiac output syndrome on 7th and 9th day after operation respectively, and their donor heart cold ischemic period were 327 and 293 min respectively. The rest of patients all recovered and discharged. One died of acute rejection on 18th month after operation because of rejecting immunosuppressive agents, and 1 died in traffic accident on 23rd month after transplantation. The rest 57 cases survived 6-59 months(mean 35 months), and had good life quality with NYHA cardiac function classification in 0-I grade. Conclusions Heart transplantation with donor aged over 40 may also have satisfactory results. Patients with endstage dilated cardiomyopathy can procure donor heartsfrom donors with heavy weight. Using different techniques to procure donor hearts may furthest reduce myocardial injury. Donor hearts which have been protected by myocardium protecting liquid for a long time should be used with caution.
The experience on management of abnormal blood vessels in 128 cases of donor kidney during the tailoring operation was reported. The various techniques used for different types of abnormal arteries and veins, and the critical points which should be paid attention to have been discussed. It was concluded that the multiple renal arteries should be treated in a single renal artery and anastomosed with internal iliac artery or/and external iliac artery. The appropriate management given to abnormal renal blood vessels during the tailoring operation may shorten the warm ishemia time, ensure the renal blood supply, reduce the renal vasular complication, and promote the recovery of renal function.
Objective To summarize the clinical experience of harvesting the lung of a brain death donor by international standardized methods, so as to establ ish a set of standards and regulations appl icable for harvesting the lung of brain-death donors in China. Methods The operation was performed on 1 brain-death donor who had endured 50 hours of mechanical ventilation. The donor was assessed by donor lung function test and international brain death standard. Then the organ was perfused and trimmed ready for lung transplantation. Results We succeeded in harvesting the heart, lung, liver, kidney and cornea from this brain-death voluntary donor. The harvested lung was successfully transplanted into a recipient. And the recipient recovered well after operation. Conclusion The successful experience of harvesting the lung of the brain-death voluntary donor will contribute to the development and promotion of the utilization of brain-death donor suppl ies.
linically,free neurovascular warparound flap big toe is generally used as one of the methods forthe reconstruction of thumb. The fate of the donor foot , and the various problems brought about bythe transfer, however, had not drawn enough concentration from the surgeons.Free warparound flap transfer was performed on 107 patients and 62 cases of the total werefollowed-up. It was found that the results of the transfer were generally satisfactory to the thumb,but much were complained about ...
ObjectiveTo more comprehensive understanding the survival situation of donors after liver transplantation, which can be applied to clinical diagnosis and treatment. MethodsThe related literatures in recent years of living donor liver transplantation (LDLT) postoperative complications, quality of life, and liver regeneration were reviewed, and the donors postoperative survival situation were investigated. ResultsLDLT has become an option, It is safe and feasible for healthy adults to donate partial liver for LDLT. ConclusionsDonor postoperative survival situation is very important, and it affect the development of LDLT.To improve donors postoperative survival situation, we still need more efforts.
Abstract: Although lung transplantation has been established as the only valid therapeutic approach for endstage pulmonary disease, several related problems remain to be solved. In addition to the serious problem in donor lung shortage, primary graft dysfunction caused by lung ischemia-reperfusion injury is one of the most common reason of early mortality. Optimal preservation of lung is essential to reduce ischemic organ dysfunction after lung transplantation. The development of a highly reliable lung preservation solution that reduces ischemia-reperfusion injury will improve the functioning of transplanted lungs. The progress of the type, perfusing technique or strategies and modified methods of lung preservation solution are reviewed in this article.
Objective To review the researches of donor nerve’s promoting effect on regeneration of reci pient nerve in end-to-side neurorrhaphy at home and abroad. Methods The latest original l iterature concerning donor nerve’s accelerating effect on regeneration of recipient nerve was extensively reviewed. Results Proper nerve cutting may promote nerve regeneration. But how to quantize the cutting volumn was still a challenge. Conclusion It is important to research thedonor nerve in neurorrhaphy, which can provide evidence for cl inical neurorrhaphy so as to achieve good results.