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 introduce the treatment and clinical result of reconstructing femoral artery with external jugular vein graft. Methods From June 2002 to April 2006, 22 cases of femoral artery defects caused by pseudoaneurysm resection, were reconstructed withexternal jugular vein graft by microsurgical technique. There were 20 males and2 females, aging 25-46 years (mean 31.2 years). The length of femoral artery defects was 5-9 cm, with an average of 6.8 cm. The location was left in 14 cases and right in 8 cases.Results Ten cases achieved healing by the first intention, and 4 cases by the second intention. The other 8 cases need the regional flap repair because the wound splited open and became ulcer. Femoral artery defects were reconstructed successfully and the pulse of dorsal arteries of foot could be felt except 1 case of bleeding of anastomotic rupture. Eighteen patients were followed up 1-30 months, and no pseudoaneurysm recurred. Color ultrasound Doppler detection showed that the external jugular veins took place of the femoral artery defects in 12 cases. Conclusion External jugular vein is stable at anatomy and easy-to-obtain. Its calibre is close to that of the femoral artery. It can be used for reconstructing femoral artery defects as the vein material. The operation is easy and the clinical result is sure.
Objective To review the research progress of composite tissue allotransplantation (CTA), analyzethe superiority and the inferiority, and inform the possible direction of further research. Methods Literature concerningCTA was reviewed and analyzed in terms of the l imits of conventional reparative and reconstructive surgery, the definitionof CTA, potential advantages, and treatment risks. Results The cl inical research of CTA both at home and abroad proved that the therapeutic effect of CTA was better than that of conventional reparative and reconstructive surgery. However, therisks resulting from immunosuppressive therapy were still the primary factors restraining the wide cl inical appl ication ofCTA. Conclusion The development of immunosuppressive therapy explores a great development potential for the CTA, and how to decrease the treatment risk of immunosuppressive therapy will be the main research direction in the field of CTA.
Objectives To investigate the curative effect of skin flap and allogenic tendon in reconstructing l imbs function of complex soft-tissue defect. Methods From May 2001 to December 2007, 43 cases of complex soft-tissue defect of l imbs were repaired by pedicled skin flaps, free skin flaps, cutaneous nerve nutrient vessel skin flaps and arterial island skin flaps for primary stage, then the function of the l imbs were reconstructed with allogeneic tendon after 2-3 months of skin flapoperation. There were 31 males and 12 females, aged 5-53 years(mean 25 years). Injury was caused by machine in 28 cases, by traffic accident in 14 cases and others in 1 case. There were 27 cases in upper l imb, 16 cases in lower l imb. Twenty-six cases compl icated by bone fracture, dislocation and bone defect, the most of bone defect were cortical bone defect. The sizes of skin and parenchyma defect were 9 cm × 4 cm to 37 cm × 11 cm, the length of tendon defect was 6 to 26 cm. The sizes of skin flaps were 10 cm × 5 cm to 39 cm × 12 cm. Allogeneic tendons were used 2-6 strips(mean 4 strips). Results Forty-three cases were followed up for 5-56 months (16 months on average), all flaps survived. The donor area healed by first intention, the incision healed by first intention in second operation, and no tendon rejection occurred. The cl inical heal ing time of fracture was 3-8 months, and the cl inical heal ing time of allograft was 6-8 months. Six cases were given tenolysis for adhesion of tendon after 3-5 months of tendon transplantation. The postoperative flexion of wrist joint was 20-50°, the extension was 20-45°. Articulatio metacarpophalangea and articulatio interphalangeae could extend completely. The flexion of articulatio metacarpophalangea of thumb was 20-45°, the flexion of articulatio interphalangeae was 30-70°. The flexion of articulatio metacarpophalangea and articulatio interphalangeae of the other fingers was 60-90°. The postoperative ankle can extend to neutral position, the neutral position of ankle was 30-50°. The flexion of articulatio metatarsophalangeae and articulatio interdigital was 20-40°. Theextension of articulatio metatarsophalangeae was 30-60°. Conclusion Through designing systematically treatment plan,practicing operation by stages, preventing adhesion of tendon actively and exercising function reasonably, the functions of l imbs reconstructed by allogenic tendon and skin flap can leads to satisfactory effect.
Objective To evaluate 5 different kinds of perforator flaps for repairing soft-tissue defects and reconstructing the breast and tongue after the breast or the tongue resection.Methods From June 2005 to June 2006, 31 free or pedicled perforator flaps were used to repair the softtissue defects or reconstruct the organs in our hospital. The free anterolateral thigh flaps (ALT) were used in 16 cases to repair the soft-tissue defects in the head and neck after resection of malignant tumors, including malignant melanoma in 9, squamous carcinoma in 4, basaloma in 2 and malignant fibrous histocytoma in 1.Among them, 3 ALT flaps were used for reconstruction of the tongue after resection of the tongue (3/4); the maximum area of the flap was 26 cm×15 cm. The deep inferior epigastric perforator flaps (DIEP) were used in 10 cases, and the free transverse rectus abdominis myocutaneous flaps (FTRAM) were used in 2 cases to reconstruct the breast.Secondary reconstruction was performed in9 cases, immediate reconstruction with the skin-sparing mastectomy at the sametime was performed in 3 cases. The bilateral breast reconstruction was performed in 3 cases and the unilateral breast reconstruction was performed in 9 cases. The breast reconstruction was performed in 1 case using the superior gluteal artery perforator flap (SGAP) and the inferior gluteal artery perforator flap (IGAP), respectively. One case had an uncovered bone (6 cm × 4 cm) in the middle andlower parts of the right cnemis, which was repaired by the pedicled local posterior tibial artery perforator flap (PTA,15 cm × 5 cm). The donor sites were sutured directly in 27 cases, the ALT flap in 3 and PTA flap in 1 were covered by the epidermal skin graft. Results The follow-up for 3-6 months revealed that in the 31 cases (33 free flaps, 1 pedicled flap), only 1 had a total necrosis of the transferred ALT flap for the neck defect repair after resection of the neck tumor, which was caused by the venous insufficiency. There was nopartial necrosis in the remaining ALT flaps. There was a partial fat liquefaction in the DIEP flap, and a pain of abdomen in the FTRAM flap. The distal partial necrosis occurred in the pedicled PTA flap (2 cm×1 cm) in 1 case, as a result of the venous insufficiency, which was managed successfully using daily dressings. One SGAP and one IGAP survived. ConclusionAlthough the perforator dissection is difficult and the vascular anatomy is complicated, application of the perforator flaps to repair of the softtissue defects and reconstruction of the organs is still an important step forward becaue of the minimal donor site “cost” and the maximal efficacy.
ObjectiveTo review the research progress of the biomechanics of proximal row carpal instability (IPRC). MethodsThe related literature concerning IPRC was extensively reviewed. The biomechanical mechanism of the surrounding soft tissue in maintaining the stability of the proximal row carpal (PRC) was analyzed, and the methods to repair or reconstruct the stability and function of the PRC were summarized from two aspects including basic biomechanics and clinical biomechanics. ResultsThe muscles and ligaments of the PRC are critical to its stability. Most scholars have reached a consensus about biomechanical mechanism of the PRC, but there are still controversial conclusions on the biomechanics mechanism of the surrounding soft tissue to stability of distal radioulnar joint when the triangular fibrocartilage complex are damaged and the biomechanics mechanism of the scapholunate ligament. At present, there is no unified standard about the methods to repair or reconstruct the stability and function of the PRC. So, it is difficult for clinical practice. ConclusionSome strides have been made in the basic biomechanical study on muscle and ligament and clinical biomechanical study on the methods to repair or reconstruct the stability and function of PRC, but it will be needed to further study the morphology of carpal articular surface and the adjacent articular surface, the pressure of distal carpals to proximal carpal and so on.
Objective To observe the cl inical outcome of treating blepharophimosis-ptosis-epicanthus inversus syndrom (BPES) by means of primary and complex recection of levator palpebrae superioris musculus. Methods From May 2001 to May 2007, 12 patients with BPES were treated, including 6 males and 6 females aged 4-15 years old (average 7 years old).All patiens marked signs of BPES— typical ptosis of the upper eyel ids, epicanthus inversus, palpebral fissure, and increased distance between inner canthus.The eye fissure width was (2.8 ± 1.8) mm, the eye fissure length was (19.8 ± 4.7) mm, and the inner canthic diameter was (41.6 ± 6.5) mm.The muscular strength of levator palpebrae superioris was deficient in 4 cases, the muscular strength of levator palpebrae superioris was (2.0 ± 0.6) mm in 8 cases.All patients were associated with visual function congenital defects of varying degrees.The surgical technique included shortening of the internal canthal l igaments, recection of the tarsus and levator muscle, and skin plasty. Results All the incisions healed by first intension.Twelve patients were followed up for 12-48 months (average 30 months).Amel ioration of ptosis and epicanthus was achieved.At 18 months after operation, the eye fissure width of 10 petients was (9.0 ± 2.1) mm, the eye fissure length was (26.5 ± 3.5) mm, and inner canthic diameter was (30.2 ± 2.7) mm, the muscular strength of levator palpebrae superioris increased to (5.6 ± 1.9) mm, showing significant difference when compared with preoperation (P lt; 0.05). Conclusion The primary and complex recection of levator palpebrae superioris musculus can provide relating good cosmetic and functional results for the correction of BPES. Patients with BPES should receive surgery as early as possible.
Objective To review the progress in the treatment and research of massive rotator cuff tears. Methods Recent l iteratures about the treatment and research of massive rotator cuff tears were reviewed. Results Treatment options of massive rotator cuff tears include nonoperative treatment, debridement, direct repair, tendon transfer, and repair with various substitutes, but the outcome is unpredictable. Recently, many experimental studies on the treatment of massive rotator cuff tears, such as gene therapy, cell therapy, and tissue engineering techniques, can provide cl inicians with new treatment strategies. Conclusion The treatment of massive rotator cuff tears pose a distinct cl inical challenge for the orthopaedist, depending on the overall presentation. The effect of traditional operation method to repair massive rotator cuff tears is limited. The treatment and research of massive rotator cuff tears still need to be studied.
Objective To evaluate the long-term function of the traumaticallydamaged joint after its repair with transplantation of a fresh or a frozen allogenic joint. Methods From March 1977 to September 1993, 13 patients (9 males, 4females; age, 17-55 years) with traumatically-damaged joints underwent transplantation of the fresh or the frozen allogenic joints. Five patients had 5 damagedmetacarpophalangeal joints, 6 patients had 9 damaged interphalangeal joints, and 2 patients had 2 damaged elbow joints. So, the traumatic damage involved 13 patients and 16 joints. All the metacarpophalangeal joints and the interphalangeal joints were injured by machines and the 2 elbow joints were injured by road accidents. The patients were randomly divided into 2 groups: Group A (n=7) andGroup B (n=6). The 7patients with 8 joints in Group A underwent transplantation of fresh allogenic joints; the 6 patients with 8 joints in Group B underwent transplantation of frozen allogenic joints. The allogenic joint transplants were performed in the period from immediately after the injuries to 6 months after the injuries. The motion ranges of the transplanted joints and the X-ray films were examined after operation, and the immunological examination was performed at 8 weeksafter operation. Results The time for synostosis was 5-8 months in Group A, but4-6 months in Group B. In Group A, at 2 years after operation the metacarpophalangeal flexion was 30-40° and the interphalangeal flexion was 20-30°; however,at 6 or 7 years after operation the interphalangeal flexion was only 10-20°. The patients undergoing the transplantation with fresh elbow joints had the elbowflexion of 60° and the elbow extension of 0°, and had the forearm pronation of 30°and the forearm supination of 30°. But in Group B, at 2 years after operation the metacarpophalangeal flexion was 6070° and the interphalangeal flexionwas 40-50°; at 6 or 7 years after operation the interphalangeal flexion was still 40-50°. However, the patients undergoing the transplantation with frozen elbow joints had the elbow flexion of 90° and the elbow extension of 0°, and hadthe forearm pronation of 45° and a forearm supination of 45°. The joint motion ranges, the Xray findings, and the immunological results in the patients undergoing the transplantation of the frozen allogenic joints were significantly better than those in the patients undergoing the transplantation of fresh allogenicjoints. There was a significant difference in the immunological examination between Group A and Group B (IL2, 21.64±3.99；CD4/CD8,3.88±0.82 vs.IL-2,16.63±3.11；CD4/CD8, 2.53±0.23, P＜0.01). Conclusion Repairing the traumatically-damaged joints with frozen allogenic joints is a better method of regaining the contour, movement, and complex motion of the hands.
To investigate the effect of BMSCs on the repair of digestive tract injury and its mechanisms.Methods Recent l iterature on the effect of BMSCs on the repair of digestive tract injury was reviewed. Results BMSCs had the potency of self-repl ication, prol iferation and multipotential differentiation, which played an important role in the repair of digestive tract injury. The probable mechanisms included: BMSCs’ abil ity of migrating to the injured tissue and inhibiting the host immune response; BMSCs’ dedifferentiation and redifferentiation; BMSCs’ direct differentiation into the epithel ial cellsor the stem cells of digestive tract; BMSCs’ fusion with the stem cells or the mature epithel ial cells of digestive tract; BMSCs’ participation in the reconstruction of injured microenvironment. Conclusion BMSCs participates in the repair of digestive tract injury and has a bright future in the treatment of digestive system disease.