【摘要】 目的 探討肥胖人群減肥后體重急劇下降導致腹壁松弛行腹壁整形手術的療效。 方法 2003年4月-2009年10月，24例減肥后體重下降導致腹壁松弛患者中男3例，女21例，年齡28~44歲，平均36歲。其中1例合并甲狀腺功能亢進，1例合并糖尿病病史；20例均通過運動、控制飲食等方式致體重下降，4例接受胃減容手術后體重下降。體重下降穩定后至腹壁整形手術時間間隔2~4年，平均2.5年；減肥前至腹壁整形手術前體重下降37~67 kg，平均下降45 kg。手術采用屈髖位，切除松弛皮膚組織，收緊腹壁及腰部松弛組織，恥骨上沿皮瓣遠端去表皮后與恥骨上沿骨膜縫合固定。所有患者隨訪5個月~2年。 結果 23例術后2周皮瓣完全成活，切口愈合良好，無切口感染；1例術后出現恥骨上切口約2 cm表皮裂開，換藥2周后切口愈合，術后腹壁平整、對稱，無皮下血腫發生。隨訪期間切口疤痕隱蔽，陰阜無上移，腹壁平坦、對稱。 結論 該腹壁整形手術方式效果良好，術后并發癥少，值得推廣。From April 2003 to October 2009, 24 obese patients, including three males and 21 females, developed abdominal chalastodermia caused by weight loss. Their age ranged from 28 to 44 years old with an average age of 36 years. Among them, one had hyperthyroidism and one had a medical history of diabetes. Twenty patients lost weight by exercise and diet, while the other four lost weight through stomach reduction surgery. Time span from weight loss to abdominal plastic surgery was two to four years, averaging at 2.5 years. During the time from before weight loss until the surgery, weight loss ranged from 37-67 kg, averaging at 45 kg. The surgery adopted the position of bending hip. The loose skin was removed; abdominal wall and loose waist tissues were tightened; and the far end of flap without skin along the upper edge of pubis was sutured with the periosteum. All patients were followed up for a time ranged from five months to two years. Results Flaps survived within two weeks after the surgery, incision healed perfectly, and no infection occurred to the incision for all the patients except in one case, there was a 2 cm of skin fissure in the upper incision which was cured after two weeks of dressing. After the surgery, the abdominal wall was flat and symmetrical without subcutaneous hematoma. During the follow-up, scars were well hidden, mons pubis was not shifted upward, and the abdominal wall was flat and symmetrical. Conclusion The abdominal wall plastic surgery has a good clinical outcome with few complications, which is worth being popularized.
Objective To summarize the treatment of chronic osteomyel itis of the skull and its effectiveness. Methods Between January 2004 and February 2009, 24 patients with chronic osteomyel itis of skull were diagnosed and treated, including 16 males and 8 females with an average age of 45.6 years (range, 18-56 years). The mean disease duration was 5.8 years (range, 3-11 years). The causes included infection after craniotomy in 3 cases, burn in 15 cases, and electrical injury in 6 cases, and the leision was located at the frontal and parietal of the skull in 10 cases, at the temporal and parietal of skull in 8 cases, and at the occipital of the skull in 6 cases. The soft tissue defects ranged from 7 cm × 6 cm to 19 cm × 12 cm, and the skull defects ranged from 5 cm × 4 cm to 10 cm × 7 cm. After wide thorough debridement of necrotic tissue, soft tissue defects were repaired with adjacent scalp flap in 12 cases, trapezius myocutaneous flap in 6 cases, and free anterolateral thigh flap in 6 cases; the flap size ranged from 8 cm × 7cm to 20 cm × 13 cm. The donor sites were sutured directly or covered with spl itthickness skin. Results All pathological examinations showed pyogenic osteomyel itis of the skull, and local ized squamous carcinoma was found in 1 case. One patient had sub-flap infection at 2 weeks after operation, and heal ing was achieved after surgical removal of residual tissue; the remaining flaps survived, and incision healed by first intention. All patients were followed up 10 months to 4 years with an average of 2 years after operation. The color and texture of the flaps were good. No recurrence of osteomyel itis happened during follow-up. The patient diagnosed as having local ized squamous carcinoma was followed up 4 years without recurrence. At 3 to 6 months after operation, 8 patients had headache or felt dizzy, and the skull was reconstructed by the titanium meshes. Conclusion In patients with chronic osteomyel itis of skull, the infected foci should be cleaned out thoroughly as early as possible, and the skin flap or myocutaneous flap is used to repair the wounds, thus the good results can be achieved.
To investigate the effect of hepatocyte growth factor (HGF) on prol iferation of cultured human eccrine sweat gland epithel ial cells (hESGc) and the involvement of phosphorylation of ERK1/2. Methods hESGc were cultured in keratinocyte serum free medium (KSFM) and the first generation of hESGc was harvested. The expression of C-met was detected by immunocytochemistry. MTT assay was used to detect the effect of HGF on the prol iferation of hESGc. The cells were divided into blank group, control group and experimental group. The culture density was 2 × 103 cells/hole in control group and experimental group. Two hundred μL KSFM with HGF in different levels was added to every hole. hESGcwere cultured in KSFM with HGF at different levels (2, 20, 40 and 80 ng/mL) in experimental group, in KSFM without HGF incontrol group, and in KSFM without HGF and no hESGc in blank group. The cell prol iferation was observed in xperimental group 2 and 4 days later. Western blot was used to detect the expression of phosphorylated ERK1/2 at 40 ng/mL HGF after 0, 5, 30, 90 and 120 minutes. Results The results were positive for anti-C-met staining in the cytoplasm. HGF (40 ng/mL and 80 ng/mL) significantly improved the prol iferation of hESGc (P lt; 0.05). When cultured in the KSFM with 40 ng/mL HGF, the cell prol iferation rate and the absorbance were 74.2%, 0.239 3 ± 0.070 9 at 2 days and 74.8%, 0.287 8 ± 0.074 3 at 4 days; showing significant differences when compared with control group (P lt; 0.05). When cultured in KSFM with 80 ng/mL HGF, the cell prol iferation rate and the absorbance were 54.5%, 0.212 3 ± 0.059 2 at 2 days and 40.3%, 0.231 0 ± 0.056 7 at 4 days; showing significant differences when compared with control group (P lt; 0.05). The expression of p-ERK1/2 reached to the maximum after stimulation of 40 ng/mL HGF for 5 minutes, and relative integral absorbance (RIA) was 0.593 2 ± 0.192 2, increased 8.1 times compared with instant stimulation (P lt; 0.01). Conclusion HGF could induce the prol iferation of hESGc and activate the phosphorylation of ERK1/2 protein.
Object ive To explore a method to recons t ruct eccr ine sweat gland- l ike s t ructure in vitro. Methods Isolated from the normal axillary full-thickness skin donated by volunteers sweat gland epithel ial cells were cultured in vitro and were observed under inverted phase contrast microscope. These cells at the density of 2 × 105/cm2 were inoculated underneath the Matrigel (group A), on the top of the Matrigel (group B) and in the Matrigel (group C), respectively,for three-dimensional culture. The formation of eccrine sweat gland-l ike structure was observed by confocal laser scanning microscope, HE staining and immunohistochemistry staining. Results Primary epithel ial cells in the secretory portion of sweat gland were attached and spindle-shaped 24 hours after inoculation, and were under polyclonal grain-l ike growth 2-3 days thereafter. Cobblestone-l ike appearances of these cells were evident 14 days after inoculation and the confluent cells were flat and polygonal with relatively big round cell nucleus. Morphologically, subcultured cells at passage 1 were similar to the primary cells; cells at passage 2 were irregular and most of them had long pseudopodium; cells at passage 3 were star-shaped and big and had fusion with adjacent cells. For group A, tubular structure was formed 11 days after three-dimensional culture. For group B, stretched and filamentous-shaped cytoplasm was observed 8 hours after three-dimensional culture, with the formation of lumen or half-lumen structure, but no significant prol iferation was evident. For group C, cell division and prol iferation occurred 2-3 days after three-dimensional culture; the prol iferated cells were closely arranged into tubular structure with obvious lacunae in the middle, which gradually developed into irregular ball-shaped structure with the increase of neonatal cells. The laser scanning confocal microscope observation showed the formation of spherical structure in group C, with tubular structure in the center of cell mass; HE staining testified the spherical structure in group C was tubular structure. The immunohistochemistry staining demonstrated keratin 18 and carcinoembryonic antigen were positively expressed in group C, which was similar to the tubular structure of secretory portion of sweat gland. Conclusion The sweat gland epithel ial cells can be induced to form eccrine sweat gland-l ike structure through three-dimensional culture in Matrigel.