Objective To compare the reconstructive method of oral and maxillofacial defect with free tissue flaps. Methods The clinical materials were collected from 1 973 reconstructive cases between January 2000 and June 2004 and analyzed in terms of the distribution of age, gender,disease type, defect location, reconstructive method and the incidence of vascular crisis of free flaps as well as success rate of free flap respectively. SAS 6.12 was adopted for statistical analysis. Results A total of 1 973reconstructive cases includded 764 in middle age (＞45 years to ≤60 years, 38.72%), 527 in old age (＞60 years, 26.71%), 450 young adults (＞28 years to ≤45 years, 2281%), 187 in young age (＞14 years to ≤28 years, 9.48%) and 45 children(≤14 years, 2.28%). The ratio of male to female was 1.5∶1. The ratio of benign to malignancy lesion was 1∶1.94. The tongue defect accounted for 20.63%, followed by mandibular defect(1738%), parotid defect(13.74%)，buccal defect(12.72%), maxillary defect(8.16%), oral pharynx defect (7.60%), floor of mouth defect(5.68%) and others (14.09%). Vascular free flap transfers accounted for 45.82%(90.4), followed by axial flap(38.17%,753), random flap(10.19%,201), avascularizedbone graft (1.52%, 30) and others(4.30%, 85). The most frequently used flap was the forearm flap(594 cases), followed by the fibula free flap(143 cases) and the pedicled pectoralis major myocutaneous flap(369 cases); these three flaps accounted for 56.06% (1 106/1 973).In 47 free tissue flaps(5.20%) having vascular crisis, 30 were saved (63.83%). The success rate of total free tissue flaps was 98.19%(923/940). Conclusion The majority of reconstructive cases of oral and maxillofacial defects is the middle aged andthe old aged male patients with malignancy. The tongue defect accounts for about one fifth of all the cases. The vascularized free flap has a high success rate, so it is a main method for reconstruction of oral and maxillofacial defects. The forearm flap, the fibular free flap and the pedicled pectoralis major myocutaneous flap are the main management for repairing oral and maxillofacial defects.
To review the progress in the treatment of chronic Achilles tendon rupture. Methods Recent l iterature on the treatment of chronic Achilles tendon rupture was reviewed. Results The choice of operative method for the repair of chronic Achilles tendon rupture depended primarily on the length of tendon defect, the atrophic condition of triceps surae muscle, and the age and the sportive level of patient. Conclusion Most chronic Achilles tendon ruptures should be treated operatively to reach good functional recovery, and tissue engineering provides a promising future for tendon defect repair.
Objective To evaluate the effect of WO-1 on repair of the bone defect in the New Zealand rabbit radius by an oral or local administration. Methods Bone defects were surgically created in the bilateral radii of 36 Zealand rabbits (1.6-2.0 kg), which were randomly divided into3 groups. In Group A, the defective areas were given WO-1 0.1 ml (50 mg/ml) by the local injections; in Group B, the rabbits were given WO-1 5 mg each day by the oral administration. Group C was used as a control group. Among each of the 3 groups, 4 rabbits were randomly selected and were sacrificed at 20, 30 and 60 days after operation, respectively. Then, the serological, X-ray and histological examinations were performed. Results The serum alkaline phosphatase and bone glaprotein levels were significantly higher at 20 and 30 days after operation in Groups A and B than in Group C, but significantly lower at 60 days after operation in Groups A and B than in Group C（Plt;0.01）. The X-ray and histological examinations at 20, 30 and 60 days after operation revealed that the callus formation and remodeling were earlier in Groups A and B thanin Group C, and the remodeling was earlier and better in Group A than in Group B. Conclusion WO-1 can promote the repair of the radial defect in a rabbit; however, further studies on the doseeffect relationship, administration time, and administration route are still needed.
Objective To probe into the surgical methods and therapeutic effect of repairing old calcaneal tendon rupture and defects with tissue engineered tendons. Methods The tissue engineered tendons were prefabricated by co-cultivatingallogeneic tendon cells with composite of carbon fiber and polyglycolic acid for 5 days. From August 1999 to June 2002, 7 patients with calcaneal tendon rupture and defects (5-7 cm in length) were treated with tissue engineered tendons. The defects were repaired by suturing repeatedly with tissue engineered tendons. Meanwhile, the defects were covered by gastrocnemius fascial flap for protection and strengthening. After surgery, the ankle joints were fixed with plaster 4to 6 weeks, and then the functional exercise was done. Results All the patients were followed up 22 to 56 months (46.9 months on average). Six patients achieved healing by the first intention, only one patient had delayed union. No local or systemic complication occurred in all the cases. No patients were given the second operation for adhesion. In accordance with YIN Qingshui’s criterion for therapeutic effect,the results were excellent in 5 cases, good in 1 case and moderate in 1 case. Conclusion Repairing old rupture and defects of calcaneal tendon withtissue engineered tendons can achieve good clinical outcome, it is an optional therapy.
Objective To study the difference of repairing segmental bone defect with bio-derived bone preserved by various methods.Methods Freeze-dried biomaterials had been stored in two different preservation solutions for three months,while the biomaterials stored for same period were observed as control group. The experimental model of 15 mm radial segmentaldefect was made in 60 New Zealand white rabbits, which were divided into groups A,B and C according to transplant materials preserved by various methods. Groups A and B were deeply divided into A1 and A2 subgroups, B1 and B2 subgroups according to whether materials were cocultured with osteoblasts. Tissue engineered bone was used to repair bone defects of left limbs in A1 and B1 subgroups, while simple material to repair defects of right limbs in A2 and B2 subgroups. Group C was divided into C1 and C2 subgroups. Freeze-dried material was used to repairbone defects of the left limbs, while defects of the right limbs as blank control group. The samples were harvested and observed by the roentgenographical, histomorphological, biomechanical and computerized graphical analysis at 4,8 and 16 weeks. Results All of the defects treated with implants exhibited new bone formation 4, 8 and 16 weeks postoperatively, increasing with time. The radiological, histomorphological and biomechanical evaluation showed that the ability of new bone formation was arranged in 6 subgroups as follows:A1gt;A2gt;C1gt;B1gt;B2gt;C2, the difference was significant between them (P＜0.001, P＜0.05).The ability of new bone formation was best and at 16 weeks the defect was bridged with the appearance of marrow cavities in A1 subgroup, the biomechanicalproperties in implants approached to those of normal bone. Conclusion The choice of proper preservation solution can improve the ability of repairing bone defect.
ObjectiveTo compare the effectiveness of complex defects repair between using chimeric anterolateral thigh flap and series-wound flaps after resection of oral and maxillofacial cancer. MethodAfter resection of oral and maxillofacial cancer, defect was repaired with chimeric anterolateral thigh flap in 39 patients between January 2011 and July 2014 (chimeric anterolateral thigh flap group); and defect was repaired with series-wound flaps in 35 patients between January 2009 and December 2010 (series-wound flaps group). There was no significant difference in gender, age, duration of disease, tumor type, tumor staging, defect location, and defect area between 2 groups (P>0.05) . The operation time, flap harvesting and microvascular anastomosis time, stomach tube extraction time, and oral feeding time were recorded and compared between 2 groups, and postoperative complications were observed; the effectiveness was evaluated according to clinical efficacy evaluation table of bone and soft tissue defects reconstruction surgery in oral and maxillofacial region. ResultsVascular crisis occurred in 2 cases of chimeric anterolateral thigh flap group, and 4 cases of series-wound flaps group. Partial necrosis appeared at distal end of a series-wound flaps, and oral fistula and infection developed in 3 series-wound flaps. The other flaps and the grafted skin at donor site survived; wounds at recipient site healed by first intention. The operation time, stomach tube extraction time, and oral feeding time of chimeric anterolateral thigh flap group were significantly shorter than those of series-wound flaps group (P<0.05) , while the flap harvesting and microvascular anastomosis time was significantly longer than that of series-wound flaps group (P<0.05) . The patients were followed up 1-5 years (mean, 2.5 years). At 3 months after operation, the appearance, patients' satisfaction, working conditions, oral closure function, chew, language performance, and swallowing scores of the chimeric anterolateral thigh flap group were significantly better than those of the series-wound flaps group (P<0.05) , while there was no significant difference in diet, mouth opening degree, oral cavity holding water test, and occlusion scores between the 2 groups (P>0.05) . ConclusionsUsing chimeric anterolateral thigh flap for defect repair after resection of oral and maxillofacial cancer can significantly shorten the operation time, accelerate postoperative rehabilitation, and help the functional recovery of oral closure, chewing, language performance, swallowing function when compared with the series-wound flaps.
Objective To observe the long-term clinical results of repairing large articular cartilage defects of the hip and the knee with free autogeneous periosteum. Methods Based on the results of experimental studies, the authors used free autogeneous periosteum transplantation and postoperative continuous passive motion (CPM) to repair large articular cartilaginous defects in 52 patientsfrom February 1987 to August 1995. Of 37 patients with complete follow-up data, 16 had congenital dislocation of the hip, 6traumatic arthritis of hip, 1 femoral head destruction following mild infection, 2 ankylosing spondylitis, 6 intra-articular fracture of the knee, 4 arthritisof the knee and 2 stiff knee following joint infection. The patients with dislocation of hip were given relieving traction before operation. The cartilages of pathological changes were excised to bleeding bone. The defects were repairedwith periosteum removing from tibia. CPM were immediately applied for 4-6 weeksand no bearing was allowed 6 months after discharge. The silicon membrane was taken out in the 6th month. Results Thirty-seven patients (17 males, 20 females) were followed up 7-15 years with an average of 10.5 years. The functional evaluation referred to joint pain degree，joint mobile range，daily activity and X-ray findings. The results were excellence in 11 patients , good in 18 patients , poor in 8 patients. Conclusion The method to repair articular cartilage defect with free autogeneous -periosteum is effective and may be applied clinically.
OBJECTIVE: To explore the anatomical basis of blood supply and heel reconstruction by reversed island fibular musculocutaneous flap. METHODS: The blood supply of fibular musculocutaneous flap and the biomechanical characteristics of heel were studied by anatomical examination. One case with right heel full defect because of explosion injury was repaired by transfer of reversed island fibular vessels. The fibular flap was 14 cm in length with part of peroneus muscle and long flexor muscle of great toe. RESULTS: The lower part of fibular artery had plentiful anastomosis with anterior tibial artery and posterior tibial artery, which could provide ideal reversed blood supply. The rotatory point of vessel pedicle could be chosen according to the need of operation. The lowest site might be above 6 cm to lateral malleolus, and the vessel pedicle was 20 cm in length. The morphological feature of the reversed island fibular musculocutaneous flap was suitable to the biomechanical character of heel. The patient achieved satisfactory clinical result, the musculocutaneous flap survived well for 10 months of follow-up. CONCLUSION: The reversed island fibular musculocutaneous flap provide a new method for repairing the severe heel defect, especially in full defect of calcaneus and cuboid bone.
Objective To evaluate the clinical effect of end-to-end neurorrhaphy following rapid expansion of the nerve in repairing facial nerve defect. Methods From August 2000 to February 2005, 9 patients suffering from facial nerve defect were treated by the surgical method. The defect was caused by traffic injury(4 cases) , by cutting injury (2 cases) and falling wound(1 case). Seven cases showed prominent facial paralysis. The other 2 cases were invaded by parotid carcinoma, without remarkable paralysis. One case had unibranch defect, and the other 8 cases had multibranch defect. The nerve gap ranged from 1.5cm to 3.0 cm. After both the proximal and the distal segment had been dissected,the nerve was elongated by the expander designed and manufactured. The expansionwas done at a speed of 2.0 cm/30 min, and it lasted until the end-to-end neurorrhaphy can be done easily. The treatment result was evaluated according to Baker’s classification and HouseBrackmann’s grading system. Results Nine patients were followed up 618 months. In 5 cases achieving good result, both dynamic look and static look of face were symmetric, the EMG peak value of mimetic muscle was 82%95% of normal side. In 3 cases achieving fair result, thedynamic look and static look of face were basically symmetric, and the EMG peak value of mimetic muscle was 60%90% of normal side. In 1 case achieving poor result, the function of mimetic muscle was improved slightly, and the EMG peak value of mimetic muscle was 55% of normal side. Conclusion The satisfactory resultcan be obtained by endtoend neurorrhaphy following rapid expansion of the nerve in condition that nerve defect is less than 3.0 cm.
Objective To explore the clinical effect of the lower rotating point super sural neurocutaneous vascular flap on the repair of the softtissue defects in the ankle and foot. Methods From May 2001 to February 2006, 24 patients with the soft tissue defects in the ankle and foot were treated with the lower rotating point super sural neurocutaneous vascular flaps. Among the patients, 15 had an injury in a traffic accident, 6 were wringedand rolled by a machine, 1 was frostbited in both feet, 2 were burned, 25 had an exposure of the bone and joint. The disease course varied from 3 days to 22 months; 19 patients began their treatment 3-7 days after the injury and 5 patients were treated by an elective operation. The soft tissue defects ranged in area from 22 cm × 12 cm to 28 cm × 12 cm. The flaps ranged in size from 24 cm × 14cm to 30 cm × 14 cm, with a range up to the lower region of the popliteal fossa. The rotating point of the flap could be taken in the region 1-5 cm above thelateral malleolar. The donor site was covered by an intermediate thickness skingraft. Results All the 25 flaps in 24 patients survived with asatisfactory appearance and a good function. The distal skin necrosis occurred in 1 flap, but healing occurred after debridement and intermediate thickness skin grafting. The follow-up for 3 months to 5 years revealed that the patients had a normal gait, the flaps had a good sense and a resistance to wearing, and no ulcer occurred. The two point discrimination of the flap was 5-10 mm. Conclusion The lower rotating point super sural neurocutaneous vascular flap has a good skin quality, a high survival rate, and a large donor skin area. The grafting is easy, without any sacrifice of the major blood vessel; therefore, it is a good donor flap in repairing a large soft tissue defect in the ankle and foot.