Ten cases of basicranial repair and reconstruction after resection of malignant tumors in nasal sinuses invading base of skull were reported. Dural repair was performed when the resected basicranial osseous lamella was less than 3 cm in diameter; when the lamella ranged from 4 to 7 cm, bone graft was not required either, the defect was repaired with either fascia lata and pericranium of pedunculated galea aponeurotica or frontal myocutaneous. No leakage of cerebrospinal fluid, cerebral hernia and intracranial infection happened postoperatively.
Objective To evaluate the effect of the modified extended iliofemoral approach on treatingcomplex acetabular fractures. Methods Thirty-six cases of complex acetabular fractures were treated by the open reposition and internal fixation by a modified extended iliofemoral approach. Results Thirty-sixcases were followed up for 7-46 months, with an average of 23.8 months. According to the Matta standard, anatomical reposition was performed in 24 cases, perfect reposition in 8 cases, and unsatisfactory reposition in 4 cases. By the modified d’Aubignepostel score, among the 36 cases, 22 had an excellent result, 9 had a good result, and 5 had a poor result. Conclusion Themodified extended iliofemoral approach facilitates the operative exposure of the anterior and posterior walls and both columns of the acetabulum in the surgically-treated acetabular fractures by the open reposition and internal fixation.Because of the reconstruction, the functions of the abductor muscle mass managed by the lagscrew-fixed osteotomies of the iliac crest, and greater trochanter, the patients can achieve a rapid rehabilitation of the joint.
ObjectiveTo investigate the clinical application of the modified bilobed flap in the reconstruction of zygomatic-facial massive defect after resection of skin cancer. Methods Between August 2009 and October 2011, 15 patients with skin cancer in the zygomatic-facial region underwent defect reconstruction using modified bilobed flaps after surgical removal. There were 12 males and 3 females, aged 52-78 years (mean, 64.1 years). The disease duration was 1-14 months (mean, 4.6 months). Among the patients, there were 11 cases of basal cell carcinoma and 4 cases of squamous cell carcinoma; 1 patient had infection and the others had no skin ulceration; and tumor involved the skin layer in all patients. According to TNM staging, 13 cases were rated as T2N0M2 and 2 cases as T3N0M3. The defect size ranged from 4.0 cm × 2.5 cm to 6.5 cm × 4.0 cm after cancer resection. The modified bilobed flaps consisting of pre-auricular flap and post-auricular flap was used to repair the defect after cancer resection. The size ranged from 4.0 cm × 2.5 cm to 6.5 cm × 4.0 cm of the first flap and from 3.0 cm × 2.0 cm to 5.0 cm × 3.0 cm of the second flap. ResultsPartial incision dehiscence occurred in 1 case, and was cured after dressing change; the flaps survived and incision healed primarily in the other cases. Fourteen patients were followed up 12-24 months (mean, 18.7 months). No recurrence was found, and the patients had no obvious face asymmetry or skin scar with normal closure of eyelid and facial nerve function. At last follow-up, the results were very satisfactory in 5 cases, satisfactory in 7 cases, generally satisfactory in 1 case, and dissatisfactory in 1 case. ConclusionThe pre- and post-auricular bilobed flaps could be used to reconstruct the massive defects in the zygomatic-facial region after resection of skin cancer.
Seventy-four cases of peripheral arterial injuries in recent 30 years were reported. Mostof them were main arteies in extremeties. Twenty-eight cases were performed end to end anastomosis and 7 of them received amputation for various complications. We also performed 12 cases of reparatidn of wall, 20 cases of vascular grafts and 7 cases of arterial ligation. There were 16 cases of amputation and one death. We think that artemal injuries should be operated as soon as possible. Arteial reconstruction was mostly used, including reparation of wall, end-to-end anastomosis and autovenous graft. Other procedures should be emphasized, such as complete debridement of the soft tissue and vessels, appropriate fixation of fracture, exploration and reconstruction of major veins, enough decompression of interfascia compartment, proper drainage of would and good surgical skill. Local and general anticoagulation were good to treatment of arterial injuries during and after operation .
Objective To study diagnosis, treatment and rebuilding of scrotum gangrene. Methods From January 1992 to September 2004, 15 patients with scrotum gangrene were treated and their clinical data were analysed.Their ages ranged from 23 to80 years. The results of bacterial culture were positive for wound sample in 14 cases and for blood in 1 case. All the patients underwent surgical treatment including incision,aggressive debridement,drainage,irrigation and antibiotic therapy. Two patients accepted hyperbaric oxygen therapy. All the patients received scrotum rebuilding by transfer of skin flap, skin grafting and suturation and orchectomy was given in 2 elder patients. Results All the patients received healing by first intention after 21 to 34 days.There was no death. Aftera follow-up of 1 to 3 years, the appearance of scotum was satisfactory and no orchiatrophy occurred. Thirteen patients with testicles had normal sexual function. Conclusion After a definite diagnosis,early aggressive debridement,broad-spectrum antibiotics and sufficient local drainage should be used. If available,hyperbaric oxygen therapy may be used to promote healing of tissue wound. Scrotum should be rebuilt based on different conditions.
Objective To investigate the effectiveness of groin flap combined with medial plantar artery perforator flap (MPAP) for degree Ⅲ-Ⅳ defects of multiple fingers. Methods Between January 2018 and June 2019, 12 patients with degree Ⅲ-Ⅳ defects of multiple fingers caused by crushing were admitted. There were 9 males and 3 females with a median age of 29 years (range, 16-42 years). The mean interval between the injury and admission was 3 hours (range, 1-9 hours). The injured fingers of 7 cases were index and middle fingers, 4 cases were middle and ring fingers, and 1 case was index, middle, and ring fingers. All fingers were taken thorough debridement and covered by the vacuum sealing drainage device during the emergency operation. The mean interval between the debridement and flap repairing was 18 hours (range, 12-36 hours). During the first-stage operation, the iliac bone graft was used to reconstruct bone frame, and the proximal interphalangeal (PIP) joint from the foot was transferred as the digital PIP joint, then the thin groin flap and MPAP were tailored to cover the dorsal and palmar defects, respectively. The size of the groin flap was 7.0 cm×4.5 cm-14.0 cm×9.0 cm, and the size of the MPAP was 8.0 cm×4.5 cm-14.0 cm×6.5 cm. The abdominal donor site was directly sutured, and the foot was repaired with full-thickness skin grafting. The flaps were separated into the finger shape at the second-stage. Results All the flaps survived, and the wounds healed by first intention; the incisions in the donor site healed by first intention, and the skin grafts survived completely. All patients were followed up 12-18 months (mean, 16 months). At last follow-up, the injured finger was similar to the contralateral one in terms of texture, appearance, and color. The mean two-point discrimination was 8 mm (range, 6-10 mm), and the sensate level recovered to the S3-S4. According to the Michigan Hand Outcomes Questionnaire (MHQ), the reconstructed hand function was excellent in 8 cases and good in 4 cases. There was no complication in the donor sites. Conclusion The degree Ⅲ-Ⅳ defects of multiple fingers were repaired by the groin flap and MPAP, and the reconstructed fingers can perform good texture and motion with being sensate, with less sacrifice on the foot.
OBJECTIVE: To compare the effect of several types of rib rings with intercostal muscles for the replacement of trachea in thorax. METHODS: The surface layer of the third rib of dogs were ripped off and curved into triangular, quadrilateral and polygonal form. These three types of rib rings with intercostal muscles were used to replace a segment of trachea in thorax. RESULTS: The stability of triangular rib ring was very well, but stricture of ring were often happened because of its smaller internal diameter. These stability of quadrilateral rib ring was the worst. The polygonal rib ring presented the biggest diameter and good stability compared to the other two kinds of rings. If silicone tube was supplemented in the polygonal rib ring, the quality of artificial trachea was excellent. CONCLUSION: The rib rings with intercostal muscles are successfully used for replacing the defect of trachea in canine thorax. The polygonal rib rings have the best quality in the three types of rib ring for tracheal replacement.
One hundred and twenty-eight cases of peripheral aneurysm were reported.Traumatic prsucdoaneursyms(87cases)dominated and aneurysm in lower extremities(68 cases)consisted of most the cases.Rupture of aneurysm and massive kaemomhage is the most serious complications(22 cases in the report).Therefore,operative treatment should be performed soon after the diagnosis is ascertained.Resteration of normal blood flow should be the aim.Intracystic repairation is indicated in pseudoaneurysm with part of the vascular wall invaded.Artificial graft may be indicated for aneurysm of the middle and large artery,and autovenous graft for the smaler arteries.Aneurysm may be resected if the procedure is easy to perform or there is severe inflammation around the aneurysm.Proper postoperative drainage is important.General heparinization during blockade of local circulation is also important in case of vascular grafting. We concluded that proper selection of operative procedure is essential for better prognosis.
Objective To explore the clinical effect of different types of free tissue transplantation on repairing tissue defects and reconstructing functions. Methods From November 2001 to September 2004, 14 types of freetissue transplantation and 78 free tissue flaps were applied to repairing tissue defects and reconstructing functions in extremities and maxillofacial region in 69 cases. Of the 69 cases, there were 53 males and 16 females (their ages ranged from 18 to 56, 31 on average). Five cases were repaired because of skin defects in foot, 22 cases were repaired because of skin defects in leg, 36 cases were repaired as the result of skin defects in hand or forearm and finger reconstruction, 3 cases were restored by virtue of ulna or radius defects, and 3 cases were repaired in maxillofacial region. There were 55 cases of open wound, in which 16 cases were infectious wound, 6 cases were osteomyelitis or pyogenic arthritis. There were 14 cases of noninfectious wound. The area of these tissue flaps ranged from 2.0 cm×1.5 cm to 43.0 cm×12.0 cm. The length of bone transplantation ranged from 10 cm to 15 cm. Results Arterial crisis occurred in 2 cases, venous crisis occurred in 2 cases.Seventysix flaps survived completely and 2 flaps survived partially which werelater healed. Fiftytwo cases were healed at stageⅠ, 13 cases were healed at stageⅡ(healing time ranged from 20 to 30 days), purulent infection occurred to 4cases(healing time ranged from 3 to 11 months). Bone healing time ranged from 6 to 8 weeks in finger reconstruction. Bone healing time ranged from 4 to 6 months in fibula transplantation. The function reconstruction and appearance were satisfying. The functions of all regions, where free tissues were supplied, were not disturbed. Conclusion Tissue transplantation and composite tissue transplantation are effective in repairing tissue defects and reconstructing functions.
Objective To review various kinds of therapeutic methods for restenosis after reconstructive vascular operation. Methods The literatures about prevention and treatment for restenosis after reconstructive vascular operation were reviewed. Results Therapeutic methods for vascular restenosis include gene therapy, drug treatment, placing external stent around the vein graft and physical therapy. The methods of gene therapy include transferring genes that inhibit the proliferation of vascular smooth muscle cell (VSMC) and inactivating genes that promote the proliferation of VSMC through technology of antisensenucleic acids or RNA interference. Conclusion Current treatment for restenosis after reconstructive varscular operation have both advantages and disadvantages, some of which are still being disputed. With the development of the technology of molecular biology, gene therapy would be the most effective therapy method for vascular restenosis.