Objective To investigate short-term clinical outcomes of double-modified Limberg flap transplantation in treatment of sacrococcygeal pilonidal sinus. Methods One hundred patients with sacrococcygeal pilonidal sinus from October 2010 to May 2015 in this hospital were included, and subsequently were divided into double-modified Limberg flap transplantation group (double-modified flap group,n=30), classical Limberg flap transplantation (classical flap group,n=30), and interrupted suture after resection group (interrupted suture group,n=40). The duration of operation, intraoperative bleeding, hospital stay, duration of return to work, recurrence rate, and incision complications rate were compared among these three groups. Results ① The age, gender, body mass index, and preoperative complications had no significant differences among these three groups (P>0.05). ② The intraoperative bleeding and the hospital stay had no significant differences among these three groups (P>0.05). Compared with the interrupted suture group, the durations of operation were significantly longer (P<0.05), the durations of return to work were significantly shorter (P<0.05), the recurrence rates were significantly lower (P<0.05) in the double-modified flap group and the classical flap group. The above indicators had no significant differences between the double-modified flap group and the classical flap group (P>0.05). ③ The incision hematoma and the part disruption of incision had no significant differences among these three groups (P>0.05). Compared with the interrupted suture group, the rates of incision infection and incision complete disruption were significantly lower (P<0.05) in the double-modified flap group and in the classical flap group. The incision maceration of the classical flap group was significantly higher than that of the interrupted suture group (P<0.05) or the double-modified flap group (P<0.05). No skin flap necrosis occurred in the double-modified flap group and the classical flap group. Conclusions Double-modified Limberg flap transplantation and classical Limberg flap transplantation have less complications and lower recurrence rate than interrupted suture after resection. Compare with classical Limberg flap transplantation, double-modified Limberg flap transplantation has a lower incision maceration rate. Because of limitation of sample size in this study, long-term clinical efficacy of double-modified Limberg flap transplantation needs to be confirmed by multicenter randomized controlled trials.
OBJECTIVE To determine the role of endogenous carbon monoxide(CO) in oxidant-mediated organ injury following limb ischemia-reperfusion (I/R) in rats. METHODS: Sixty-four SD rats were divided into 4 groups: Sham group, Sham + zinc protoporphyrin (ZnPP, an inhibitor of heme oxygenase activity), 2-hour ischemia followed by 4-hour reperfusion (I/R) group and I/R + ZnPP group. Carboxyhemoglobin (COHb) level in the artery blood, malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in the lung, heart, liver and kidney were detected. The 24-hour survival rate of rats was studied. RESULTS: Compared with the sham group, the COHb level and MDA content significantly increased, while the SOD activity and the survival rate significantly decreased in I/R group (P lt; 0.05). Compared with the I/R group, MDA content significantly increased, while the SOD activity, the 24-hour survival rate and COHb level significantly decreased in I/R + ZnPP group (P lt; 0.05, respectively). CONCLUSION: Limb I/R could lead to the oxidant-mediated multiple organ injury accompanied by the increase of CO level which play an important role in the defense against I/R-induced remote multiple organ injury in rats.
OBJECTIVE To emphasize the importance of reconstruction and repair after resection of soft tissue sarcoma. METHODS From November 1990 to November 1996, in 107 cases of soft tissue sarcoma 32 cases had received various reconstructive or reparative operations. Among the 32 cases, 4 cases were primary sarcomas and 28 cases were recurrent sarcomas. In surgical grading, 3 cases were of I B, 3 cases of II A and 26 cases of II B. Radical resection was performed in 13 cases, widen local resection in 17 cases and local excision in 2 cases. After operation, 13 cases received chemotherapy and 7 cases received radiotherapy. Reconstruction of blood vessels was performed in 3 cases, reconstruction of kinetic function in 16 cases, and repair of defect was carried out in 23 cases. RESULTS Thirty patients were followed up for 4 months to 6 years and 6 months. The clinical results showed that the local control rate of sarcoma was 80%, limb-salvage rate after reconstruction of blood vessels was 100%, the excellent and good rate after reconstruction of kinetic function was 87.5%, and the survival rate of the tissue flap of transplantation and transposition was 96%. CONCLUSION It was concluded that the reconstruction and repair after resection of soft tissue sarcoma was the extension of operative treatment, and was very important in lowering the recurrence rate and improving the life quality of the sufferings.
Objective To study the clinical feasibility of the prosthetic composites of the intercalary allograft and the segmental allograft in reconstruction of the skeletal defect after the limb tumor resection. Methods Between August 1999 and December 2003, 28 patients with skeletal defects after the limb tumor resection were treated with the intercalary allograft or the segmental allograft megaprosthesis composite for reconstruction of skeletal defects. The bone involvements were observed in 16 patients with osteosarcoma, 4 patients with parosteal osteosarcoma, 5 patients with Ewing sarcoma, and 3 patients with soft tissuesarcoma. Preoperative biopsy was performed on all the patients, and the pathological result was confirmed after surgery. According to the Enneking system, 5 patients were grouped in ⅠB and 23 patients in ⅡB. The patients with osteosarcomaor Ewing sarcoma received the standard chemotherapy before and after operation.Eighteen and ten patients received the segmental allograft prosthetic compositereplacement and the intercalary allograft with the interlocking intramedullary nail fixation, respectively. The functional outcome was evaluated by the MSTS score. Results According to the follow-up for 5-48 months (average, 24 months), local recurrence was observed in 1 patient who underwent amputation eventually. Of the 28 patients, 3 developed nonunion of the allografthost junction accompanied by severe resorption and 2 developed deep infection. No allograft fracture was seen in the patients. Most of the patients achieved a good functional result with an average MSTS score of 23.4. ConclusionThe prosthetic composite replacement of the intercalary allograft and the segamental allograft can be used n the skeletal defect reconstruction after the limb tumor resection. The stablecontact in the allografthost junction and the b intramedullary internal fixation can help to reduce the complication rate of the allograft.
Objective To investigate the application of abdominal aorta and bilateral abdominal perineal artery ligation in a hindlimb ischemia model of rats for research. Methods According to the random digits table, 38 SD rats were divided into 3 groups randomly, sham operation group (SO group, n=12), abdominal aorta ligation group (AAL group, n=12) and abdominal aorta and bilateral abdominal perineal artery ligation group (AAL+BAPA group, n=14). Rats were anesthetized by 6 mg/100 g ketamine via intraperitoneal injection. Blood vessels were ligated via laparotomy according to different procedures. Movement and pale skin color of rat’s hindlimb were observed on 2 and 4 weeks after operation, meanwhile venous blood from unilateral iliac vein was obtained for blood gas analysis and hindlimb skeletal muscle for HE stain. Results Two rats were dead during 3 d after operation in AAL+BAPA group, other rats survived. Rats in SO group had no obviously abnormal appearance. AAL group and AAL+BAPA group immediately presented hindlimbs pale, lower skin temperature, hypofrontality of limb motion after procedure. Symptoms above mentioned had improved gradually after 2 weeks and completely recuperated 4 weeks after operation in AAL group. Ischemia symptoms were still remained obviously such as cold, dried and thin on the 4th weekend in AAL+BAPA group. Each group had no hindlimbs necrosis. Two weeks after operation, pale limbs and muscle strength in AAL+BAPA group were more severe than those of SO group (Plt;0.05); Pale limbs was still worse than that of AAL group on 4 weeks after operation (Plt;0.05). There were no significant differences on different time in each group (Pgt;0.05). Venous blood partial pressure of oxygen of AAL+PABA group was significantly lower than that of the other two groups on 2 and 4 weeks after operation (Plt;0.05). Normal striated muscle structure was presented in SO group pathologically. AAL group revealed coloretur unevenness, swelling and distension, muscle cellular transverse striation elimination, skeletal muscle cell nucleolus deeply stained on the 2nd weekend and no difference with the SO group on the 4th weekend. AAL+BAPA group presented skeletal muscles decoration unevenness, cells swelling and distension, muscle cellular transverse striation elimination, skeletal muscle cell nucleolus stained deeply and intensively, intercellular space widening until the 4th weekend， but no obviously necrocytosis. Conclusion The method of ligating abdominal aorta and bilateral abdominal perineal artery can make a stable SD rat model of hindlimb ischemia
OBJECTIVE To investigate the factors which affect the bone union of distracted region after limb lengthening, so as improve the curative effect and diminish the incidence of complication. METHODS To look up the latest literatures dealing with the bone union in limb lengthening, then review the procedure of osteogenesis and the affecting factors. RESULTS The osteogenesis of distracted region after limb lengthening is a sophisticated procedure. It can be affected by the velocity of lengthening, the period of lengthening, the site and method of osteotomy, the age etiology of patient. CONCLUSION The bone union of distracted region after limb lengthening can be facilitated by following factors: 1. the velocity of lengthening slower than 1.0 mm/day; 2. moderate delay in distraction; 3. axial shortening of distracted region; 4. micromovement stimulation.
OBJECTIVE: To summarize the application of simple skin traction technique in repair of soft tissue defect of limb. METHODS: From 1999, 42 cases of soft tissue defect of limbs were repaired by simple skin traction technique instantly; the defect area ranged from 2.5 cm x 2.0 cm to 8.0 cm x 6.5 cm. RESULTS: The soft tissue defect less than 8.0 cm can be sutured instantly. All of the wound achieved primary healing without infection and necrosis of skin edge, the circulation and sensation of limbs were normal; healing time was 10 days to 16 days, 12.8 days on average. Thirty-two cases were followed up for 6 months; the shape and function recovered well. CONCLUSION: Simple skin traction technique is a good option to repair the soft tissue defect of limbs.
Objective To explore the cl inical outcomes of repairing l imb wound with distal based neurocutaneous flap. Methods From June 2003 to June 2009, 187 cases with wounds in the hand, foot, and distal leg were treated. There were127 males and 60 females aged 20-70 years old (average 37.5 years old). The wound was caused by traffic accident in 130 cases, crush injury in 38 cases, machinery accident in 16 cases, and explosion injury in 3 cases. Among them, the soft tissue defect was in the dorsal and palmar aspects of the hand in 35 cases, the distal leg in 50 cases, the dorsal aspect of foot in 40 cases, the region around ankle in 27 cases, the tendon area in 11 cases, the medial side of foot in 4 cases, the heel and sole of foot in 5 cases, and the forefoot area in 15 cases. The size of skin soft tissue defect was 5.0 cm × 3.0 cm-17.5 cm × 10.0 cm. Four cases suffered from nonunion of heel and 15 cases suffered from tibia defect (3-7 cm). The course of disease was 3 days-8 years. During operation, 35 cases with wound in the hand were treated with three types of lower rotation point of forearm neurocutaneous flaps with rotation points 0-3 cm above the wrist joint, 66 cases were treated with distal based saphenous nerve and saphenous vein neurovascular flaps, muscle flaps and bone flaps with rotation points 2-5 cm above the medial malleolus, and 86 cases were treated with sural and saphenous flaps, muscle flaps and bone flaps with rotation points 1-5 cm above the external malleolus. The flap was 5 cm × 3 cm-17 cm × 15 cm in size, the muscle flap was 5 cm × 3 cm × 1 cm-10 cm × 6 cm × 2 cm in size, the fibula flap was 4.0 cm × 2.5 cm-10.0 cm × 8.0 cm in size. The l igation of the superficial veins was performed below the rotation point of the flap in 163 cases, and the cutaneous nerve ending anastomosis was performed in 22 cases. The donor site was repaired byspl it thickness skin grafting from the inner side of the thigh. Results Various degree of skin flap swell ing occurred, and the swell ing extent in the patients receiving the superficial vein l igation was obvious less than that of patients with no l igation. At 4-7 days after operation, 6 cases had necrosis at the edge of flaps and 6 cases had bl ister, all of them healed after changing dress. The rest skin flaps and skin grafting in the donor site survived uneventfully, and the incision healed by first intention. All the patients were followed up for 2 months to 3 years. The appearance of the flap was satisfactory, the hand function and the foot function of walking and weight-bearing recovered. The two point discrimination of the patients 1 year after cutaneous nerve ending anastomosis was 8-12 mm. The grafted fibula in the patients with bone defect reached union 8-10 months after operation. The appearance and the movement of the donor site were normal. Conclusion The new type distal based neurocutaneous flap has such advantages as simple operative procedure, less invasion, high survival rate, and recovery of the sensory function of the hand and the foot. It is suitable to repair the tissue defect in the hand, the foot, and the distal leg.
Objective To investigate the clinical application and early results of combined epiphyseal preservation and autograft bone transfer for limb salvage in children with osteosarcoma. Methods Between March 2010 and March 2011, 3 children with osteosarcoma were treated with epiphyseal preservation and autograft bone transfer. There were 1 boy and 2 girls with the age of 10-14 years. The disease duration was 2 weeks to 3 months. The tumors were rated as type II according to San-Julian radiological classification and as type IIB according to Enneking surgical classification. The locations were the distal femur in 1 case and the proximal tibia in 2 cases. The surgical technique included preoperative neoadjuvant chemotherapy, excision of part of the epiphysis, preservation of subarticular epiphysis, external fixation with Ilizarov apparatus and transport osteogenesis treatment. Safe excision border was confirmed by histological examination. Postoperative observation included the wound healing, local recurrence or distant metastasis, length, speed, alignment, and regeneration of transplanted bone, the length and function of the affected limb. Results The postoperative histological examination proved the safe surgical margin in all 3 patients. The incision healing by first intention was obtained at distal femur in 1 case and by second intention at proximal tibia in 2 cases at 4 weeks after changes of dressing. Three patients were followed up 12, 18, and 24 months, respectively. There was no local recurrence or distant metastasis during follow-up. Two cases had pin-tract infection at 10 months after external fixation and were cured after changes of dressing and antibiotics administration. The length of transplanted osteogenisis was 18.0, 9.5, and 16.0 cm, respectively. The speed of lengthening was 2.57, 2.07, and 1.20 cm/month, respectively. One patient had alignment deviation during lengthening, which was adjusted under anaesthesia. Bony healing was achieved at 8 months after lengthening end in 2 cases and external fixation was removed; 1 patient had poor bone growth and was given retraction for promoting bone growth. At last follow-up, the length of the affected limbs was 1.0-1.5 cm shorter than that of normal limbs, but no abnormalities was observed at donor sites. The affected knee flexion reached 90° and 120° in 2 patients and poor knee function was observed in 1 patient for external fixation. Conclusion The combined epiphyseal preservation and transport osteogenesis technique can be used for bone defect repair by lengthening the residual bone. It is a promising limb salvage treatment for children with osteosarcoma.
Objective To evaluate the effectiveness of soft tissue reconstruction after resection of musculoskeletal tumor and to discuss the strategy of soft tissue reconstruction. Methods Between June 2003 and December 2010, 90 patients with musculoskeletal tumor underwent tumor resection and soft tissue reconstruction. There were 59 males and 31 females with a median age of 37.2 years (range, 9-85 years), including 52 bone tumors and 38 soft tissue tumors. One stage reconstruction of soft tissue was performed after tumor resection in 75 cases; reconstruction of soft tissue was performed after debridement in 7 cases of wound dehiscence; and two stage reconstruction of soft tissue was performed after debridement and vacuum sealing drainage placement in 8 cases of infected wounds. The gastrocnemiums flap was used in 40 cases, the latissimus dorsi myocutaneous flap in 6 cases, rectus abdominis myocutaneous flap in 4 cases, gluteus maximus musculocutaneous flap in 1 case, pectoralis major muscle flap in 1 case, cross-abdominal flap in 1 case, local transfer flap in 27 cases, pedicled flaps in 5 cases, and skin grafts in 5 cases. The size of the flap ranged from 6.5 cm × 4.5 cm to 21.0 cm × 9.0 cm. Results Eighty-seven flaps survived, and incisions healed by first intention in 81 cases. In 6 cases of healing by second intention, 2 had partial flap necrosis, which was cured by dressing change; 3 had delayed healing; 1 had mild infection, which was cured after conservative treatment. Wound of donor site healed primarily, and the grafted skin survived. Seventy-three patients were followed up 10-102 months (mean, 36.1 months). Local tumor recurrence was observed in 6 patients, who received second resection at 2-27 months (mean, 8.2 months) after operation. Thirteen patients dead of primary disease at 6-34 months (mean, 19.2 months) after operation. Conclusion The defects caused by resection of musculoskeletal tumor require soft tissue reconstructions. Optimal reconstruction can enhance wound closure, decrease incidence of wound complication, preserve limb function.