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.
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.
Objective To investigate the expression of c-kit in human intermediate-spl it-thickness skin grafts and normal skin, and to recognize the role of c-kit in hyperpigmented process of the skin grafts. Methods The hyperpigmented intermediate-spl it-thickness skin grafts of 16 patients’ face and cervicum 1 year after operation was harvested and the normal skins around the recipient site and the donor site were used as controls. Envision immunohistochemical technique was usedto detect the expression and distribution of c-kit in the skin grafts and in the normal control skins, respectively. Medical image quantitative analysis system was used to quantitate the positive expression index (PI). Results The expression of c-kit was located in endochylema and cytolemma of melanocytes and keratinocytes in the basilar part of epidermis. The positive expression of c-kit was obvious in the intermediate-spl it-thickness skin grafts and blown zone was observed in the basilar part of epidermis; and was not obvious and local in normal control skins. The PI of c-kit in the intermediate-spl it-thickness skin grafts (131 216 ± 19 130) was significantly higher than that in the normal skin around the recipient site (92 958 ± 16 208) and in the normal skin around the donor site (91 306 ± 8 135); showing statistically significant difference (P lt; 0.05). Conclusion The expression of c-kit in intermediate-spl it-thickness skin grafts increases remarkably compared with that in normal control skin. c-kit may play an important adjusting role in the process of hyperpigmentation of skin grafts．
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.
Objective To discuss the expression of α-melanocyte-stimulating hormone(α-MSH) mRNA in human medium thickness skin autografts and to investigatethe role of αMSH in hyperpigmented process of skin autografts. Methods The samples were from medium thickness skin autografts on neck of the patients after 1 year of surgery. The size of sample was about 1.0 cm×0.5 cm. RT-PCR technique was performed to detect the expression of α-MSH mRNA in medium thickness skinautografts and normal skin respectively. Masson-Fontana stain technique was performed to detect the contents of melanin in medium thickness skin autografts andnormal skin epidermis respectively. Results The expression ofα-MSH mRNA in medium thickness skin autografts was much ber than that in control normal skin, showing statistically significant difference (P＜0.01). The expression of α-MSH/β2-microglobulin mRNA in normal skin of donor area was no statistically significant differences compared with normal skin around recipient area. The contents of melaninin medium thickness skin autografts epidermis obviously increased when compared with that of control normal skin. The expression of α-MSH mRNA was positive correlated with the contents of melanin in epidermis. Conclusion The above results indicate that the expression of α-MSH increases greater in medium thicknessskin autografts than in cortrol samples and was correlated with the pigmentation of skin autografts. Overexpression of α-MSH may play an important role in hyperpigmented process of skin autografts.
【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.
目的 探討可調節負壓引流技術結合植皮治療皮膚缺損伴感染創面的臨床效果及護理要點。 方法 對2008年5月－2011年5月收治的106例皮膚缺損伴感染創面患者，采用間歇負壓引流治療3～10 d，負壓值設為50～120 mm Hg（1 mm Hg=0.133 kPa），創面達到Ⅱ期植皮條件時，采用大張、網狀或郵票狀皮片覆蓋創面，繼續采用持續負壓引流治療3～12 d，負壓值設為50～60 mm Hg，同時進行患者心理和可調節負壓引流技術創面等護理。 結果 56例大張皮片植皮中，2例皮片出現0.5 cm×1 cm～0.8 cm×1.2 cm皮片壞死；21例郵票狀植皮者，1例出現皮片移動皺縮。除5例骨外露，先通過植皮創面縮小后行皮瓣轉移，101例創面愈合時間7～25 d，平均14 d，無因所植皮片未成活需再次植皮和因感染死亡或截肢。 結論 可調節負壓引流技術結合植皮治療皮膚缺損伴感染創面，可有效控制感染，減輕患者換藥痛苦，減少醫務人員換藥和護理工作量，加快植皮創面愈合，縮短創面治愈時間。
【摘要】 目的 探討大面積手部皮膚脫套傷并缺損的修復方式。 方法 2005年6月－2010年1月，應用腹部皮瓣包埋和游離中厚皮片植皮結合負壓封閉引流（vacuum sealing drainage，VSD）技術治療手部大面積皮膚脫套傷合并缺損12例，其中男8例，女4例；年齡21~56歲，平均34歲。機器絞傷9例，車禍傷3例。所有損傷均合并肌腱、關節或骨質外露；軟組織缺損范圍為9 cm×8 cm~25 cm×18 cm。受傷至手術時間4~17 h，平均6.5 h。手掌及手指缺損部位采用腹部帶蒂皮瓣包埋；手掌及手指以外肌肉、筋膜完好的部位采用大腿游離中厚皮片植皮，再于植皮表面覆蓋VSD敷料，接負壓行持續吸引；所有患者均二期斷蒂并進行分指或皮瓣成形手術。 結果 術后2例手指部分皮瓣或植皮壞死，2例小部分皮瓣及植皮邊緣壞死，經單純換藥后逐漸愈合，1例缺損較大、較深，先行換藥，待創面肉芽新鮮后行二期植皮手術，愈合良好 。其余皮瓣及植皮均成活，創面Ⅰ期愈合；供區植皮均成活，切口均Ⅰ期愈合。12例均獲6~42個月隨訪，2例手指末節軟組織缺損嚴重、血運差，術后7~10 d末節壞死后短縮；3例掌側皮瓣移植后較臃腫；其余外觀均較滿意。所有患者創面愈合后1個月內深、淺感覺功能均稍差，3~6個月逐漸恢復，但手指精細感覺恢復差，兩點辨別覺為6~13 mm，平均9.5 mm。所有患手平均掌指關節主動活動50°，指間關節20°。 結論 腹部皮瓣包埋和游離中厚皮片植皮結合VSD技術能較好地修復手部大面積皮膚脫套傷并缺損，是一種實用、安全且簡便的手術方法。【Abstract】 Objective To investigate the ideal repair method for large-area hand avulsed wound and soft tissue defects. Methods From June 2005 to January 2010, 12 patients with large-area hand avulsed wound and soft tissue defects were repaired with abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique. The patients included 8 males and 4 females with their age ranged from 21 to 56 years averaging at 34 years. The causes of injury were machine twist injury in 9 cases and road accident injury in 3 cases. All the injuries combined with exposure of tendon, joint or bone. The area of defects ranged from 8 cm×9 cm to 18 cm×25 cm. The time between injury and operation was 4 to 17 hours averaging at 6.5 hours. The palm of hand and fingers were repaired by abdominal pedicle skin flaps, and the dorsum of hand and wrist were repaired by skin grafting combined with vacuum sealing drainage. About 3 weeks later, all pedicles of the abdominal flaps were cut off and flaps plasty were carried out. Results All patients were followed up from 6 to 42 months with an average period of 17 months. All of the flaps and skin grafts survived. Only 6 patients had distal edge partial necrosis, and all of them healed after a short time of dressing changes or second-stage skin grafting. All skin grafts of the donor sites survived and all the wounds healed by first intention. All the injured hands recovered well to their original shape and function except partial bad skin sensation. The sense of two-point discrimination was from 6 mm to 13 mm with an average distance of 9.5 mm. The active motion of metacarpophalangeal joints averaged at 60°, and the interphalangeal articulations averaged at 30°. Conclusion Abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique can be used to repair large-area hand avulsed wound and soft tissue defects, and it is practical, safe and simple.