Eighteen cases of loss or obliteration of eye sockets from trauma or tumour were repaired with various methods: skin graft, postauricle flap with tempopostauricular blood vessel, forehead flap with temporal blood vessel and temporal flap with subcutaneous pedicle. Following 1 to 5 years follwup, the results were good and the improvement on outlooking was remarkable. The skin grafting was a simple and applicable method but it needed a longer time of blepharorrhaphy. The flap transfer was more complicated but suitable for the obliteration of the eye socket accompanied with depression deformity, but it usually would result in a secondary cicatricical malformation at the region around the eye. Thus, it was important to select a best operative method according to the specific condition.
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.
【Abstract】 Objective To explore the effect of early scrotal dermatoplasty on spermatogenic functional rehabilitation of testis in juvenile pigs with third degree burn wound of the scrotum. Methods Thirty healthy male Guizhou miniature pigs (weighing 10-15 kg, 2-month-old) were divided into 3 groups: control group (group A, n=10), natural healing group (group B, n=10), and dermatoplasty group (group C, n=10). In group A, the pig was not given any treatment; after third degree burn model of the scrotum was prepared, wounds were not treated in group B and the burn skin was excised and whole hypogastric pachydermia was used for dermatoplasty in group C. At 3 months and 1 year after model preparation, bilateral testis were collected from 5 pigs, respectively. HE staining was performed to observe the effects of different repair method on the morphology of spermatogenic cells and immunohistochemical staining was used to detect Survivin protein expression. Results All pigs survived to the end of the experiment and the wound healed successfully. Histological observation showed that spermatogenic cells had normal shape at all stages and mature sperms were seen in lumens in group A; the thickness of seminiferous epithelium was thinner, having one layer or two layers of spermatogenic cells in group B; the spermatogenic cells in group C were slightly more than that in group B with some spermatids; and in groups B and C, the spermatogenic cells at 1 year were more than that at 3 months. Immunohistochemistry staining showed that the Survivin protein expression in groups B and C was less than in group A, and group B was less than group C, showing significant differences at 3 months and 1 year (P lt; 0.05), but no significant difference between 3 months and 1 year in the same group (P gt; 0.05). Conclusion Dermatoplasty has inhibitory effect on spermatogenic functional rehabilitation of testis. Dermatoplasty can decrease spermatogenic cells and reduce Survivin protein expression, but some spermatids still survive in seminiferous tubule.
ObjectiveTo evaluate the clinical value of skin stretching device in repair of diabetic foot wound.MethodsA retrospective analysis was made on the clinical data of 48 cases with diabetic foot wound who were treated with skin stretching device (trial group, n=24) and with the vacuum sealing drainage combined with skin graft (control group, n=24) respectively between October 2015 and July 2016. There was no significant difference in gender, age, side, course of disease, TEXAS stage between 2 groups (P>0.05). Both patients in 2 groups were treated with sensitive antibiotics according to the results of bacterial culture.ResultsOne case in control group was infected and the skin graft failed, and 1 case in trial group was infected after the treatment, and the two wounds healed after symptomatic treatment. The wounds of the other patients healed successfully, and the healing time of the trial group was significantly shorter than that of the control group [(12.8±11.6) days vs. (22.3±10.4) days; t=2.987, P=0.005). All patients were followed up 3-12 months after operation, and no wound dehiscence or recurrence occurred during follow-up.ConclusionCompared with the vacuum sealing drainage combined with skin graft, the application of skin stretching device in the repair of diabetic foot wound has advantages, such as easy to operate, shorten the wound healing time, and the appearance of wound was similar with the adjacent skin.
【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.
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.
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。