Objective To review the latest research progress of full-thickness tissue engineered skin (FTTES), to thoroughly understand its current state of research and appl ication so as to lay a sol id foundation for developing new type FTTES and improving the qual ity of skin substitutes. Methods Domestical and international l iterature concerning FTTES in recent years was extensively reviewed and comprehensively analyzed. Results Some progress of FTTES had made in seedcells, scaffold materials and construction, and some therapeutic efficacy had also been achieved in cl inical appl ication. ButFTTES grafting successful rate was lower, and it had no complete skin structure and had not reached the requirements of cl inicalappl ication. Conclusion FTTES is an ideal skin substitute and has great development prospects. However, in seed cells, scaffold materials, construction and appl ications of FTTES, further studied is still needed.
【Abstract】 Objective To investigate and evaluate the effectiveness of covering amputated raw surface with freetissue transplantation from damaged limbs. Methods Between August 2010 and June 2011, 5 cases of severe injury of lower extremities were treated, including 4 males and 1 female with an age range of 3 years and 8 months to 43 years. Of them, 3 cases suffered from traffic accident injury and 2 had machine injury. The disease duration was 2-9 hours. Among the 5 cases, 1 suffered from half pelvis destruction and traumatic amputation of hip joint, 1 from comminuted open fracture of proximal femur, and another 3 from thigh destruction with survival soft tissue of legs. All cases were treated with emergency operation of amputation. The raw surface of the residual stumps was 20 cm × 10 cm to 20 cm × 20 cm in size. Two lateral anterior thigh flaps and 3 posterior tibial artery flaps were harvested from the damaged limbs. The flap size ranged from 15 cm × 10 cm to 25 cm × 20 cm. The wounds were repaired with free tissue transplantation. Results Five transplanted tissue flaps were survival. Skin necrosis occurred in the wound edge at 7-10 days postoperatively and was cured after excision of necrotic tissue, dressing change or vacuumed drainage for 1-2 months. All wounds healed and the patients were followed up 1-3 months. No sinus tract or ulceration was observed. The appearance of stumps was satisfactory. Conclusion The effectiveness of repairing amputated raw surface with free tissue transplantation from amputated limbs is satisfactory. It is an effective procedure to repair the raw surface of amputated stumps.
Objective To review the research progress of the skin flap, fascial flap, muscle flap, and myocutaneous flap for repairing soft tissue defects around the knee so as to provide information for clinical application. Methods Domestic and abroad literature concerning the methods of soft tissue repair around the knee in recent years was reviewed extensively and analyzed. Results Fascial flaps meet the requirements of thin, pliable, and tough skin in the soft tissue repair around the knee. Myocutaneous flaps and muscle flaps have more abundant blood supply and anti-infection function. Free skin flaps are the only option when defects are extensive and local flaps are unavailable. Conclusion Suitable flaps should be chosen for soft tissue repair around the knee according to defect position, depth, and extent. Fascial flaps may be selected as the first flaps for defects repair because of excellent aesthetic results and less injury at the donor site.
Objective?To investigate the method and effectiveness of perforator flaps in repairing soft tissue defects of extremities.?Methods?Between June 2002 and December 2009, 81 patients with soft tissue defect of extremities were treated. There were 69 males and 12 females with an average age of 54 years (range, 13-75 years). Defect causes were injury in 35 cases (the disease duration ranged from 1 hour to 45 days), tumor resection in 19 cases, and scar resection in 27 cases. The defect located at limb and foot in 56 cases, forearm and hand in 25 cases. The defect size ranged from 3 cm × 3 cm to 23 cm × 18 cm. The perforator flaps included the peroneal artery perforator flap in 26 cases, the radial artery perforator flap in 18 cases, the medial plantar artery perforator flap in 18 cases, and the lateral circumflex femoral artery perforator flap in 19 cases. The flap size ranged from 4 cm × 3 cm to 25 cm × 18 cm. The donor site was sutured directly or repaired by free skin graft.?Results?Partial necrosis of the flaps occurred in 4 cases at 3-7 days after operation, then the flap survived after expectant treatment. The other flaps and free skin grafts survived successfully, and the incisions healed by first intention. All patients were followed up 1 to 16 months with an average of 9 months. The appearance, texture, and colour of the flaps were similar to those of the donor site.?Conclusion?It is an effective method to use the perforator flap for repairing soft tissue defect of the extremities.
Objective To investigate the cl inical effect of Meek technique skin graft in treating exceptionally large area burns. Methods The cl inical data were retrospectively analysed from 10 cases of exceptionally large area burns treated with Meek technique skin graft from April 2009 to February 2010 (Meek group), and were compared with those from 10 casesof exceptionally large area burns treated with the particle skin with large sheet of skin allograft transplantation from January 2002 to December 2006 (particle skin group). In Meek group, there were 8 males and 2 females with an average age of 34.5 years (range, 5-55 years), including 6 cases of flame burns, 2 cases of hot l iquid burns, 1 case of electrical burn, and 1 case of hightemperature dust burn. The burn area was 82.6% ± 3.1% of total body surface area (TBSA). The most were deep II degree to III degree burns. The time from burn to hospital ization was (3.5 ± 1.3) hours. In particle skin group, there were 8 males and 2 females with an average age of 36.8 years (range, 18-62 years), including 5 cases of flame burns, 2 cases of hot l iquid burns, and 3 cases of gunpowder explosion injury. The burn area was 84.1% ± 7.4% of TBSA. The most were deep II degree to III degree burns. The time from burn to hospital ization was (4.9 ± 2.2) hours. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The skin graft survival rate, the time of skin fusion, the systemic wound heal ing time, and the treatment cost of 1% of burn area were 91.23% ± 5.61%, (11.14 ± 2.12) days, (38.89 ± 10.36) days, and (5 113.28 ± 552.44) yuan in Meek group, respectively; and were 78.65% ± 12.29%, (18.37 ± 4.63）days, (48.73 ± 16.92) days, and (7 386.36 ± 867.64) yuan in particle skin group; showing significant differences between 2 groups (P lt; 0.05). Conclusion Meek technique skin graft has good effect in treating exceptionally large area burns with the advantages of high survival rate of skin graft, short time of skin fusion, and low treatment cost of 1% of burn area.
ObjectiveTo investigate the feasibility of the free descending branch of lateral circumflex femoral artery perforator tissue flap (fascia flap plus skin flap) to repair large soft tissue defects of the extremities and its impact on the donor site. MethodsBetween January 2013 and February 2015, 9 cases of large tissue defects of the extremities were repaired with the free descending branch of lateral circumflex femoral artery perforator tissue flap. There were 8 males and 1 female, aged from 13 to 56 years (median, 36 years). The causes included traffic accident injury in 6 cases and crushing injury by heavy object in 3 cases. Soft tissue defect located at the lower limbs in 7 cases and at the upper limbs in 2 cases, including 2 cases of simple tendon exposure, 2 cases of simple bone exposure, and 5 cases of tendon and bone exposure. After debridement, the soft tissue defect area ranged from 13 cm×7 cm to 20 cm×18 cm. The tissue flaps ranged from 14 cm×8 cm to 23 cm×19 cm. The donor site was directly sutured, scalp graft was used to cover the fascia flap. ResultsAfter operation, partial necrosis of the skin grafting on the fascia flap occurred in 2 cases and healed after dressing change. Arterial crisis occurred in 1 case and the flap survived after anastomosis. The other tissue flaps survived and wounds healed by first intention. The skin grafting healed by first intention in 7 cases, by second intention in 2 cases. The patients were followed up 4-24 months (mean, 10 months). The appearance and function of the tissue flaps were satisfactory, only linear scar was observed at the donor site, which had less damage and no effect on walking. ConclusionFree descending branch of lateral circumflex femoral artery perforator tissue flap can repair large soft tissue defect of the extremities. The donor site can be sutured directly, which reduces damage to donor site and is accord with the principle of plastic surgery.
ObjectiveTo investigate the effectiveness of using radial mid-forearm perforator fasciocutaneous flap to repair soft tissue defect in lower segment of the forearm and the wrist. MethodsBetween May 2007 and July 2012, 7 cases of soft tissue defect of lower segment of the forearm and the wrist were repaired with radial mid-forearm perforator fasciocutaneous flap. There were 6 males and 1 female with an average age of 38 years (range, 22-45 years). Defects were caused by crushing injury in 4 cases with the disease duration of 3-22 days (mean, 14 days), by internal fixation of ulnar comminuted fracture in 2 cases after 16 and 20 days of operation respectively, and by focal cleaning of wrist joint tuberculosis in 1 cases after 24 days of operation. The locations of defect were the lower segment of the forearm in 5 cases and the dorsal side of the wrist in 2 cases. The area of soft tissue defect ranged from 4 cm×3 cm to 9 cm×5 cm. The size of flap ranged from 6 cm×4 cm to 12 cm×6 cm. The donor site was closed with direct suturing or skin grafting. ResultsThe intraoperative blood loss was 50-90 mL (mean, 64 mL); the operation time was 60-80 minutes (mean, 72 minutes). Six flaps survived with wound heal ing by first intention; partial flap necrosis occurred in 1 case, and delayed healing was obtained after dressing change. Skin grafting at donor sites survived with healing of incision by first intention. The patients were followed up 3-14 months (mean, 9 months). No ulcer or sinus tract was observed; all flaps showed a sl ightly swollen appearance and had normal color. ConclusionRadial mid-forearm perforator fasciocutaneous flap does not need to dissect the source of blood vessels due to constantly anatomical structure. It has the advantages of easy operation, rich blood supply, high survival rate, and satisfactory cl inical effect, so it is an important supplement of the other non-main vessel pedicle flaps to repair soft tissue defect in the lower segment of the forearm and the wrist.
ObjectiveTo observe the effectiveness of the forearm free arterialized venous flap in repairing soft tissue defect of the hand. MethodsBetween December 2008 and January 2013, 49 cases of soft tissue defects of the hand were treated. There were 39 males and 10 females, aged 16-52 years (mean, 34 years). Defect was caused by crush injury in 34 cases, cutting injury in 7 cases, avulsion injury in 5 cases, and hot crush injury in 3 cases. The locations were index finger in 21 cases, middle finger in 14 cases, ring finger in 10 cases, little finger in 1 case, and the first web space and the dorsal palm in 3 cases. The duration of injury and admission was 2-10 hours (mean, 4.5 hours). The size of defects ranged from 2.5 cm×1.5 cm to 6.0 cm×4.5 cm. Of them, 46 cases had fracture of metacarpal or finger bone and/or injury of tendon and nerve. Emergency operation was performed in 43 cases and selective operation in 6 cases. All defects were repaired by free arterialized venous flap from the ipsilateral forearm, in which the proximal ends of veins were anastomosed to artery and vein of the finger. The flap size ranged from 3.5 cm×2.5 cm to 7.5 cm×5.3 cm. The donor site was directly sutured. ResultsSeven flaps survived which was similar to physiological free flap. Mild or medium swelling and blister were observed in 39 flaps and heavy swelling and partial necrosis occurred in 3 flaps after operation. The patients were followed up 6 months-2 years (mean, 13.5 months). The flaps had soft texture, slightly bulky appearance, and deeper color than normal skin. At last follow-up, the two-point discrimination was 16-22 mm (mean, 20 mm). According to the standard for functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the results were excellent in 21 cases, good in 21 cases, fair in 3 cases, and poor in 4 cases. ConclusionIt is an ideal method to repair soft tissue defect of the hand to use forearm free arterialized venous flap. It has the advantages of massive area, no major blood vessel needed to be sacrificed, safe and easy operation, and satisfactory appearance.
OBJECTIVE: To investigate the clinical results of the medial multiplex flap pedicled with the posterior tibial vessel. METHODS: Twelve cases with soft tissue defects and bone defects of limbs were treated with the medial multiplex flap pedicled with the posterior tibial vessel from September 1992 to May 1999. Among them, bone and soft tissue defects following opened fracture in 7 cases, chronic ulcer following chronic osteomyelitis in 2 cases, melanoepithelioma in 2 cases, bone and soft tissue defects following osteoma resection in 1 case. The bone defect area was from 2.5 cm x 5.0 cm to 4.5 cm x 11.0 cm. Free graft was performed in 5 cases, bridged transposition in 3 cases and reversal transposition in 4 cases, among them, periosteal myocutaneous flap with autogenous or allogeneic bone grafting in 8 cases, myocutaneous flap in 4 cases. The area of the flaps from 6 cm x 8 cm to 12 cm x 25 cm. RESULTS: All flaps were healed by first intention, but in the distal fragments of bigger flaps were partially necrosed in 2 cases. In 10 cases bone healing were obtained after 16 weeks of operation according to the X-ray photos. All cases were followed up from 6 to 18 months. All cases achieved satisfactory result but 1 case died because of lung metastasis of osteoma. CONCLUSION: The multiplex graft pedicled with the posterior tibial vessel is an ideal graft for repairing the large soft tissue defects and bone defects, because it has such advantages as adequate blood supply, big vascular diameter, long pedicle and big dermatomic area.
ObjectiveTo assess the effectiveness of the sural fasciomyocutaneous perforator flap in repair of soft tissue defect in weight-bearing area of the foot. MethodsBetween January 2007 and September 2010, 19 patients with soft tissue defects in the weight-bearing area of the foot were treated with sural fasciomyocutaneous perforator flaps. The etiology was traffic accident in 16 patients and crush injury in 3 patients. The interval of injury and admission was 2 hours to 14 days. The size of defect ranged from 8 cm×6 cm to 26 cm×16 cm; the size of flap ranged from 7 cm×7 cm to 25 cm×12 cm. The donor sites were repaired by free skin graft. The flap survival was observed after operation, and the pain score and sensory recovery at the reci pient site were used to assess the effectiveness. ResultsThe flaps survived with satisfactory aesthetic and functional results in 18 cases. Partial flap necrosis was noted and second healing was achieved after spl it thickness skin grafting in 1 case. One case of delayed ulceration was also noted after 5 weeks, ulceration was successfully cured after wound care and avoidance of weightbearing for 2 weeks. All patients were followed up 9-25 months (mean, 14.1 months). The flaps had good appearance, without bulky pedicle. Superficial sensation and deep sensation were restored in 17 cases (89.4%) and 18 cases (94.7%) respectively at last follow-up. ConclusionSural fasciomyocutaneous perforator flap is a rel iable modality in heel reconstruction, having the advantages of low ulceration rate, good wear resistance, and good sensation recovery.