hirty-eight cases of severed levatorpalpebrae superoris muscle caused by traumawere reported- The methods how to find thesevered ends of the levator palpebrae superorismuscles and how to do the operation weresuggested. Of the 38 cases after operation, 28(73. 68 %) cases obtained symmetrical lidfissures of both eyes, 7 (18. 42%) cases had alid fissure of 1mm wider than the normal one , 3(9. 68%) cascs had 2mm a lid fissure 2mmwider. and none of them had a lid fissure 2mmwider in compariso...
There is still a controversy on the treatment of the incomplete tear of tendons.Some authors insist to suture up, and some prefer not to suture. An animal experiment was performed for this purpose. One hundred twenty tendons of chicken feet were cut transverse and oblique cuts in equal number incompletely into 25%, 50% and 75%, respectively. Sixty tendons on the left feet were sutured up with external P.P. immobilization for 3 weeks while the other 60 tendons on the right feet were not sutured but with simple dressing only. The postoperative results assessed by various methods from functional observation and histological sectionsshowed that the suture group with external immobilization had a definitely superior result than that of the nonsuture group. The tendon cut over 50% was worse than those less than 50%. There was no much difference between whether the cut was transverse or oblique.
Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
Objective To investigate the clinical application of self-settingcalcium phosphate cement (CPC) in bone defect repair of extremities. Methods From May 1998 to January 2000, 32 cases of bone defect, in 36 sites, were repairedand reviewed, aged from 4 to 59 years old (24.7 years old on average), with bone defect 2 to 125 cm2 in size (13.1 cm2 on average). The causes of the bone defect werefracture, bone cyst, iliac bone harvesting, fibrous dysplasia, enchondroma and bone tuberculosis, which involved femur, iliac, tibia, humerus, phalanx, fibula, calcaneus, talus and acetabulum. All of the cases were followed up for 1 to 23 months, 15.3 months on average, before radiographic examination. Results All operations were successful and no general response was observed in all of the cases. X-ray examination showed an integrity interface between CPC and bone. And CT showed no gap existed. There was no increase of serum calcium and phosphate levels. Conclusion CPC is applicable in the low- or non-weight-bearing site of the extremities.
OBJECTIVE To summarize and analyze the main point on the reconstruction of traumatic tissue defects of limbs with vascularized skin and multi-tissue flaps. METHODS: Sixty-seven cases of traumatic tissue defects of limbs were reconstructed with 14 kinds of skin or multi-tissue flaps. The operative methods included local transposition, cross-transposition with vessel pedicles and vessel anastomosed free transplantation. RESULTS: Forty cases with vessel anastomosed free transplantation and 26 cases with local or cross-transposition of vessel pedicled flaps were survived. In the followed up cases, 53 cases were satisfied with the outward appearance of the skin flaps. All the cases with bone flap or skin-bone flap resulted in union. And the cases with motor nerve anastomosed myocutaneous flap transplantation had recovered to 2-3 grade muscle contraction ability. CONCLUSION: It is important that the appropriate flaps and operative methods should be chosen according to the size, location, depth and structure of the tissue defects. To raise the success rate and to gain better operation effect, the correct manipulation in operation and the rational postoperative treatment are necessary.
Objective To investigate the clinical feasibility of different types of the saphenous neuro-veno-fascial cutaneous flaps. Methods From June 1996 to October 2002, 18 cases of skin defects in the knee and the lower part of the limb were treated with proximally(4 cases) or distally(11 cases) based pedicles of saphenous neuro-venofascial cutaneous flap or crossleg flap (3 cases)according to the site of defects . The sizes of the flaps ranged from 4 cm×5 cm to 9 cm×20 cm. Results The flaps survived completely in 17 cases, distal 1/5 of the flap necrosed partially in 1 case because of vein drainage disturbance. The colour and texture of flaps were excellent, the appearance and function were satisfactory after a follow up of 6-24 months.Conclusion The saphenous neuro-veno-fascial cutaneous flap is an idea flap in repairing skin defects of the knee, the leg, the ankle and the foot because it is easy to be designed and dissected and it has reliable blood supply and preserved main artery. The relationship between the septal perforating branches of the tibial posteriorartery and survival size of flap need to be investigated further.
Objective To explore the application of the improved operative technique and clinical results of sural nerve nutritional vessel axial flap repairing the soft tissue defects of the lower leg,the ankle and the foot. Methods From January 1999 to Novenber 2004,the modified flaps were applied in 22 cases of soft tissue defect on the basis of anatomy of the intermusclar septum perforating branches of peroneal artery and the sural nerve nutritional vessel.There were 14 males and 8 females. Their ages ranged from 5 to 54 years.According to the position and size of the soft tissue defects, the sural nerve nutritional vessel flap pedicled with the perforating branch of the peroneal artery in the lower leg were desingned and obtained to repair the soft tissue defects of the lower leg,the ankle and the foot.The flap size ranged from 13cm×12cm to 30cm×20cm. The vessel pedicle of perforating branches ranged from 1.7cm to 3cm.The distribution of the vessel pedicle of perforating branches ranged from4.5cm to 8cm on the lateral malleolus.The diameters of vessel ranged from 1mm to 1.2mm. Results The flap pedicle with the terminal branch of the peroneal artery was used in 13 cases, the other branches were used in 9 cases. Among of 22 cases,the sural nerve were anastomosed with the acceptor sensory nerve in 4 cases. The skin sense were satisfactory after 1 year of operationnd 2-point discrimination was 10-13mm. All flaps survived completely in 22 cases. The outline andfunction were satisfactory during 6-18 months follow-up. Conclusion The blood supply of this flap is reliable. Flap elevation is easy. The size of flap is large enough to repair skin defects of the lower leg, the ankle and the foot.
Incidences of injuries to peripheral veins indicated certain proportions among vascular injuries, most of venous injuries were accompanied by arterial injuries. Elevated venous pressure is an important factor which cause a compression syndrome in muscular compartment of the extremities when the injured major veins are ligated or not repaired. Persistent red deep color bleeding at wound site, diffusive subcutaneous hematoma, edema and cyanosis of the extremities are characteristics of the venous injuries. The examinations of Dopplor ultrasound and phlebography would be available for diagnosis of the venous injuries. The repair means include lateral sutere, vein pathch grafts, end-to-end anastomosis and autogenous venous grafts. The venous thrombosis may occur at the early phase after repair operations and also could be prevented.
OBJECTIVE To review the recent advances in fibroblast study and its role in wound repair. METHODS Recent original articles related to wound repair were retrieved extensively, and the effect of fibroblast on every stages of repair were summed up and comprehended. RESULTS Fibroblast plays important roles in granulation formation, wound contraction, matrix synthesis, wound repair, scar formation and scarless repair by means of growth factors modulation. CONCLUSION The understanding of fibroblast in the wound repair can promote the progress of biological therapy of wound repair and scar prevention.
OBJECTIVE: To sum up the experience of clinical application of distal base sural island flap. METHODS: From January 1997 to April 1999, the posterior island flap of leg pedicled with sural nerve and its nutrient vessels was applied to repair heel or dorsum of foot in 6 cases, chronic ulcer of heel in 2 cases, chronic osteomyelitis in 2 cases, scar contracture of bone defect accompanying fistulation in 1 case. The range of flap was 5 cm x 8 cm to 8 cm x 12 cm. RESULTS: All the flaps survived completely without vascular crisis. All the wounds healed by first intention. Followed up 3 to 12 months, no ulcer, osteomyelitis, fistulation were recurrence, and the sensation of flap was recovered slightly. CONCLUSION: The flap do not damage critical blood vessels and nerves, the donating region is hidden. The manual of operation is simple and blood supply of flap is sufficient. It can repair the defect of soft tissue on heel and dorsum with high survival rate.