Objective To observe the anatomic basis and the clinical application of the modified peroneal arterial cutaneous branch nutritional flap. Methods Twenty sides of lower limb of adult colyseptic cadavers and 5 sides of lower limb of adult fresh cadavers were used to detect the cutaneous branches of the peroneal artery. The position where the cutaneous branches come from the peroneal artery and the diameter of the cutaneous branches were recorded. From September 2003 to June 2005, 10 cases of skin and soft tissue defects in the region of metatarsophalangeal point with the modified peroneal arterial cutaneous branch nutritional flap, in which the cutaneous branches from the peroneal artery 11.0±1.7 cm upon the lateral malleolus were added. The defect size was 10 cm×6 cm to 15 cm×10 cm. The flap size was 11.0 cm×6.5 cm to 16.0 cm×11.0 cm. Results There is a stable cutaneous branches from peroneal artery 11.0±1.7 cm upon the lateral malleolus. The diameter of this cutaneous branches at the origin is 1.45±0.12 mm. The distance between the cutaneous branches entrance of the deep fascia and the line of the sural nerve nutritional artery flap was 15.70±1.20 mm. All 10 flaps survived. The blood supply and venous return of the skin flaps were good. The 10 patients were followed up from 6 to 12 months. The shape of the flaps was satisfactory. The texture and the color and luster of the flaps were similar to the adjacent skin. The functions of the feet were good. The twopoint discrimination was 1118 mm. Conclusion The modified peroneal arterial cutaneous branch nutritional flap has good blood supply. It can reverse to a long distance and can repair large skin defects.
Objective To investigate the method and effectiveness of repairing fingertip defects with reverse island flappedicled with terminal dorsal branch of digital artery with sense reconstruction. Methods Between December 2008 and March2010, 32 patients (40 fingers) with fingertip defects were treated. There were 20 males (23 fingers) and 12 females (17 fingers), aged from 20 to 62 years (mean, 42 years). The time between injury and admission was from 1 to 8 hours. The injured fingers included thumb (2 cases), index finger (6 cases), index finger and middle finger (3 cases), middle finger (7 cases), middle finger and ring finger (3 cases),ring finger (8 cases), ring finger and little finger (2 cases), and little finger (1 case). The defect area ranged from 1.2 cm × 1.0 cm to 2.2 cm ×1.8 cm, and the flap area ranged from 1.5 cm × 1.0 cm to 2.5 cm × 2.0 cm. The fingertip defects were repaired by the reverse island flaps pedicled with terminal dorsal branch of digital artery and branch of digital nerve, and the branch of digital nerve was anastomosed withstump of proper digital nerve. The donor sites were repaired with free skin grafts. Results Bl isters occurred in 6 cases (9 fingers) andpartial necrosis of the flaps in 2 cases (2 fingers), which were cured after symptomatic treatment. The other flaps and skin grafts survived and the wounds healed by first intention. Thirty cases (38 fingers) were followed up 6 months postoperatively. The shape, contour of the reconstructed fingertip, and motivation of the fingers were satisfactory. The superficial sensation and deep pain sensation recovered after 6 months of operation. The two-point discrimination was 4-6 mm in 24 fingers, 7-10 mm in 13 fingers, and none in 1 finger. According to the functional assessment criteria of upper l imb formulated by the Hand Surgery Branch of Chinese Medical Association, S3 was achieved in 1 finger, S3+ in 13 fingers, and S4 in 24 fingers. Conclusion It is simple and safe to harvest the reverse island flap pedicled with terminal dorsal branch of digital artery with sense reconstruction; at the same time, the blood supply of the flap is rel iable and its sense can be reconstructed. It is one of effective methods for repairing fingertip defects.
Objective：To observe the expression of gene and protein l evel of unfolded protein, glucoseregulated protein 78 (GRP78), after retinal d etachment (RD); to find out the relationship between UPR and the cell damage after RD. Methods：Eightyeight Wistar rats were divided into 2 groups: con trol group (11 rats) and RD group (77 rats). In RD group, subretinal injection with 10 mg/ml hyaluronic acid sodium was performed on the left eyes of the rats t o set up RD model, and the left eyes and retinal tissue were collected 1/2 day, 1 day, 2, 4, 8, 1 6 and 32 days after RD; there were 11 rats in each subgroup. The expression of G RP78 mRNA in retina tissue was detected by semiquantitative reverse transcript i on polymerase chain reaction (RT－PCR), the expression of GRP78 protein level wa s detected by Western blotting, and the distribution of GRP78 in each retinal lay er was observed by immunofluorescence labeling method and confocal microscopy. Results：The expression of retinal GRP78 mRNA significantly in creased in 1/2 day , 1 day, 2, and 4 days subgroups after RD (Plt;0.05). The expression of GRP7 8 protein significantly increased in each subgroup after RD compared with which in the control group, and reached the peak in 8, 16, and 32 days subgroups. The expres sion of GRP78 protein was detected in all of the retinal layers after RD. Conclusion：The protection mechanism of UPR starts up after RD, and l eads the correc t pucker of the protein and reduces cellular injury by upregulating the expres s ion of GRP78, which provide the theoretic basis for reducing the cellular injury and improving the visual function in patients with RD.
Objective To investigate the clinical effect of the reverse transposition of pedicled soleus muscle flap in repairing soft tissue defects after Pilon fracture fixation. Methods From May 2002 to June 2006, 14 patients (11 males, 3 females; aging 2050 years) with soft tissue defects afterPilon fracture fixationunderwent repairing operations with the reverse soleus muscle flaps. The soft tissue defects ranged from 7.0 cm×3.5 cm to 100 cm×60 cm. Of the patients, Pilon fractures were treated by internal fixations in 9 cases, open Pilon fractures weretreated by external fixations in 5 cases. The area of muscle flap ranged from 8.5 cm×5.5 cm to 12.5 cm×7.5 cm. Results All patients achieved primary healings, and the grafting skin survived. Twelve flaps survived completely but 2 flapshad mildinfection, which survived after dressing change. Eleven patients were followed up for 3 to 26 months, averaged 15 months. The flap appearances were good and smooth without ulceration. The dorsiflexion ranges of ankle joint were 10-25°, and plantar flexion ranges were 15-40°. The gait was normal. Conclusion The reverse soleus muscle flap is no need to reveal blood vessel pedicle and has constant position of anatomy. It has big muscle belly, convenient to move and circuitation 180°. It is profitable to reduce infection rate and to promote wound healing to raise local osteotylus.
Objective To investigate the effectiveness of distally pedicled peroneus brevis muscle flaps and reverse sural neurovascular island flaps for post-traumatic chronic calcaneal osteomyelitis and soft tissue defects. Methods Between January 2008 and January 2012, 9 patients suffering from post-traumatic chronic calcaneal osteomyelitis and soft tissue defects were treated, including 8 males and 1 female with an average age of 33 years (range, 18-46 years). The left heel was involved in 4 cases, and right heel in 5 cases. Infection occurred after reduction and internal fixation of closed fractures of the calcaneus in 7 cases, and open calcaneal fracture and soft tissue defect in 2 cases. The disease duration was 2 months to 3 years (mean, 5 months). Purulent secretion, tissue necrosis, or sinus formation was observed in all wounds. The results of bacterial culture were positive. X-ray and CT examination showed uneven density of calcaneus and bone cavity or dead bone formation. After thorough debridement, the size of bone defect ranged from 3 cm × 3 cm × 3 cm to 6 cm × 4 cm × 3 cm; the size of soft tissue defect ranged from 7 cm × 3 cm to 12 cm × 7 cm. The distally pedicled peroneus brevis muscle flaps (11 cm × 3 cm-16 cm × 4 cm) were used for bone defect repair, and reverse sural neurovascular island flaps (8 cm × 4 cm-14 cm × 8 cm) for soft tissue defect. The donor site was directly sutured in 6 cases and repaired by skin graft in 3 cases. Results After operation, reverse sural neurovascular island flaps survived in 9 cases, and all wounds healed by first intention. No necrosis or liquefaction of distally pedicled peroneus brevis muscle flaps was observed. Incision at donor site healed by first intention, and skin grafts at donor site survived. All cases were followed up 6-24 months (mean, 13.5 months). The flaps had good texture. No recurrence of osteomyelitis was observed. Basic weight-bearing walking function was restorated. No obvious calcaneal collapse happened. Conclusion The distally pedicled peroneus brevis muscle flap combined with reverse sural neurovascular island flap is one of the effective methods to treat post-traumatic chronic calcaneal osteomyelitis with soft tissue defect, with the advantages of simple operation and good blood supply.
Objective To investigate the effectiveness of reverse island flaps of digital artery parallel for repairing degloved injuries of the fingerti p. Methods Between June 2008 and January 2010, 13 cases of degloved injuries of the fingertip were treated. There were 8 males and 5 females with an average age of 34 years (range, 19-62 years). The causes of injuries were as follow: impact and press injury in 5 cases, wringer injury in 7 cases, and crush injury in 1 case. The injured fingers were comprised of index finger in 6 cases, middle finger in 4 cases, ring finger in 2 cases, and l ittle finger in 1 case. The size of skin and soft tissue defect ranged from 2.0 cm × 1.8 cm to 3.0 cm × 2.5 cm. Three cases compl icated by fracture of thedistal phalanx, 1 case by rupture of the insertion of extensor tendon, and 1 case by rupture of the insertion of flexor tendon. The average time from injure to surgery was 4 hours (range, 1 hour and 30 minutes-12 hours). Two neighboring skin flaps located in the same course of digital artery were adopted to repair defect of the fingertip. The size of proximal skin flap ranged from 1.2 cm × 1.0 cm to 2.0 cm × 1.5 cm and the size of distal skin flap ranged from 1.1 cm × 1.0 cm to 1.5 cm × 1.3 cm. The free skin grafts were used to repair the donor sites. Results Circulation crisis occurred in 1 case at 2 hours after operation and was el iminated by interval disconnecting. The other flaps and skin grafts survived and the wounds healed by first intention. The patients were followed up 6-18 months (mean, 10 months). All flaps presented the satisfactory appearance and texture, and the flexion and extension function of wounded fingers recovered to normal. Two-point discrimination ranged from 7 to 11 mm at last follow-up. According to the functional assessment criteria of upper l imb formulated by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 9 cases, good in 3 cases, and fair in 1 case with an excellent and good rate of 92.3%. Conclusion Based on the anatomical features of communicating branches of distal interphalangeal joint, two neighboring flaps located in the same course of digital artery are adopted to repair soft tissue defect of the fingertip. This surgical method is a simple and effective method.
ObjectiveTo investigate the development and clinical application of the reverse total shoulder arthroplasty. MethodsThe relative publications on reverse total shoulder arthroplasties were extensively reviewed and analyzed. ResultsReverse total shoulder arthroplasty has extensive indications, especially for pseudoparalysis caused by irrepairable rotator cuff tears with forward or upper shift of the humeral head and intact function of deltoid. The clinical research results indicate that the short-term results are satisfactory, but there are some special complications, such as scapular nothching, instability and limities of internal and external rotation. While performing this kind of operation, the selection of the approach, the determination of the prosthetic rotation center should be considered well, and the bone graft should be paid attention to when the bony defect of the glenoid and proximal humerus exists. ConclusionThe using time of the reverse total shoulder arthroplasty is short, so the long-term results should be observed. The development of computer assisted technique is hopeful to be improve the results of the reverse total shoulder arthroplasty.
【Abstract】Objective To investigate the expression of the mRNA of cancer-testis antigen 9 (CT9) gene in hepatocellular carcinoma. Methods The expression of CT9 mRNA was detected through RT-PCR in HCC tissues and their adjacent non-HCC tissues from 45 HCC patients. From CT9 RT-PCR positive products, 3 samples were selected randomly and were sequenced. ResultsCT9 mRNA was detectable in 51.1%(23/45) of HCC samples, and no expression of CT9 mRNA was detected in the adjacent non-HCC tissues. In addition, the RTPCR products were proved to be CT9 cDNA by DNA sequencing. No relationship was found between the expression of CT9 mRNA and clinical factors such as age, sex, tumor size, degree of tumor differentiation, serum αfetoprotein level and infection of hepatitis B virus or hepatitis C virus （Pgt;0.05）. ConclusionCT9 mRNA is expressed with high percentage and specificity in hepatocellular carcinomas. The CT9 gene product is a potential target for antigenspecific immunotherapy of HCC.
OBJECTIVE: To summarize the application of reversed digital artery cross-finger flap with a compound skin pedicle in soft tissue defect of hand. METHODS: From October 1997, 35 fingers of 30 cases, with soft tissue defect at the dorsal side of digital interphalangeal joint and at the fingertips, were repaired by the reversed artery cross-finger flap with a compound skin pedicle, 1.5 cm x 1.0 cm to 2.0 cm x 2.0 cm in size. All of the cases were followed up for 1-6 months and evaluated clinically. RESULTS: All of the flaps survived, with a good texture and no swelling; and there was no adverse side effect on the donor site. CONCLUSION: Reversed digital artery cross-finger flap with a compound skin pedicle is a good option to repair the soft tissue defect of hand.
【 Abstract 】 Objective To study the mRNA expression of BC047440 gene in multiplicate malignant tumor tissues and the corresponding adjacent tissues, and to investigate its roles in the carcinogenesis and development of malignant tumors. Methods Forty-eight cases of malignant tumor tissues and their adjacent non-cancerous tissues were examined. The mRNA expression of BC047440 gene in those tissues of liver cancer, cholangiocarcinoma, gastric cancer, carcinoma of large intestine, glioma, and breast cancer were measured by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). Results ① The mRNA expressions of BC047440 gene in liver cancer, gastric cancer, cholangiocarcinoma and carcinoma of large intestine were significantly higher than those in their adjacent non-cancerous tissues (Plt;0.05 or 0.01). BC047440 gene were highly expressed in both glioma and its adjacent tissues (Pgt;0.05), and poorly expressed in both breast cancer and its adjacent tissues (Pgt;0.05). ② There were close relationships between BC047440 gene expression and clinicopathologic findings of liver cancer, including tumor size and portal vein invasion (Plt;0.05). ③ There were also close relationships between BC047440 gene expression and different clinical stages in alimentary canal cancers (Plt;0.05). Conclusion The over expression of BC047440 gene may be related with the growth, infiltration and metastasis of some malignant tumors, including liver cancer, cholangiocarcinoma, gastric cancer, carcinoma of large intestine and glioma.