ObjectiveTo review the research progress of constructing injectable tissue engineered adipose tissue by adipose-derived stem cells (ADSCs). MethodsRecent literature about ADSCs composite three-dimensional scaffold to construct injectable tissue engineered adipose tissue is summarized, mainly on the characteristics of ADSCs, innovation of injectable scaffold, and methods to promote blood supply. ResultsADSCs have a sufficient amount and powerful ability such as secretion, excellent compatibility with injectable scaffold, plus with methods of promoting blood supply, which can build forms of injectable tissue engineered adipose tissue. ConclusionIn despite of many problems to be dealt with, ADSCs constructing injectable tissue engineered adipose tissue may provide a promising source for soft-tissue defect repair and plastic surgery.
目的:总结喉返神经修复重建术围手术期的护理配合。方法：我科2007年10～11月手术治疗双侧喉返神经麻痹患者3例，手术前加强患者的心理护理、密切观察病情变化，及时处理声带麻痹引起的喉梗阻、误吸、呛咳等症状。术后重视体位护理、呼吸道的管理、保证药物及时准确使用，协助患者进行正确的吞咽进食训练、声带协调运动训练等康复护理。结果：3例患者术后均获完整随访，3月后均顺利拔除气管套管，无吸气性呼吸困难，无发音困难，嗓音质量较术前明显改善。结论：良好的围手术期护理有助于手术的成功。
Objective To review the latest progress in the major biological properties of adipose-derived stem cells (ADSCs) and ADSCs assisted autologous lipotransfer in breast repair and reconstruction. Methods Recent literature about ADSCs assisted autologous lipotransfer in breast repair and reconstruction was reviewed. Results ADSCs have multipotential differentiation capacity, and they could promote angiogenesis and regulate immune reactions. ADSCs assisted autologous lipotransfer can obtain satisfactory effectiveness in breast repair and reconstruction with few complications, but more studies are needed to confirm the long-term safety. Conclusion ADSCs assisted autologous lipotransfer has good effectiveness in breast repaired and reconstruction. But further clinical trials are needed to confirm the long-term safety.
Objective To review recent advance in the application and research of three-dimensional digital knee model. Methods The recent original articles about three-dimensional digital knee model were extensively reviewed and analyzed. Results The digital three-dimensional knee model can simulate the knee complex anatomical structure very well. Based on this, there are some developments of new software and techniques, and good clinical results are achieved. Conclusion With the development of computer techniques and software, the knee repair and reconstruction procedure has been improved, the operation will be more simple and its accuracy will be further improved.
Objective To construct a new composite artificial trachea and to investigate the feasibility of trachea repair and reconstruction with the new composite artificial trachea transplantation in dogs. Methods The basic skeleton of the new composite artificial trachea was polytetrafluoroethylene vascular prosthesis linked with titanium rings at both ends. Dualmesh was sutured on titanium rings. Sixteen dogs, weighing (14.9 ± 2.0) kg, female or male, were selected. The 5 cm cervical trachea was resected to prepare the cervical trachea defect model. The trachea repair and reconstruction was performed with the new composite artificial trachea. Then fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction were conducted at immediate, 1 month, and 6 months after operation. Gross observation and histological examination were conducted at 14 months to evaluate the repair and reconstruction efficacy. Results No dog died during operation of trachea reconstruction. One dog died of dyspnea at 37, 41, 55, 66, 140, and 274 days respectively because of anastomotic dehiscence and artificial trachea displacement; the other 10 dogs survived until 14 months. The fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction showed that artificial tracheas were all in good location without twisting at immediate after operation; mild stenosis occurred and anastomoses had slight granulation in 6 dogs at 1 month; severe stenosis developed and anastomosis had more granulation in 1 dog and the other dogs were well alive without anastomotic stenosis at 6 months. At 14 months, gross observation revealed that outer surface of the artificial trachea were encapsulated by fibrous connective tissue in all of 10 dogs. Histological examination showed inflammatory infiltration and hyperplasia of fibrous tissue and no epithelium growth on the inner wall of the artificial trachea. Conclusion The new composite artificial trachea can be used to repair and reconstruct defect of the trachea for a short-term. Anastomotic infection and dehiscence are major complications and problems affecting long survival.
【Abstract】 Objective To study the repair and functional reconstruction of oropharyngeal defects after resection of advanced-stage tonsillar cancer, and to select the donor site of appropriate flap. Methods Between October 2000 and February 2010, 13 patients with advanced-stage tonsillar cancer were treated, including 5 cases of high differentiation squamous cell carcinomas and 8 cases of medium differentiation squamous cell carcinomas. There were 11 males and 2 females, with an average age of 53.6 years (range, 39-67 years). According to Union for International Cancer Control (UICC) 1997 standards of oropharyngeal cancer, 1 case was classified as T1N1M0, 2 as T2N1M0, 2 as T2N2M0, 3 as T3N1M0, 2 as T3N2M0, 2 as T4N1M0, and 1 as T4N2M0. The disease duration was 1-8 months with an average of 4.3 months. The tumor invaded lateral wall of nasopharyngeal in 1 case, lateral wall of hypopharynx in 3 cases, epiglottis in 1 case, soft palate in 4 cases, and tongue root in 3 cases. The tumor infiltrating range was from 2 cm × 2 cm to 12 cm × 6 cm. All the 13 cases underwent integrated methods of surgery and postoperative radiotherapy. After resection of tumor by combined neck-mandible-oral cavity approach, pectoralis major myocutaneous flaps were transplanted in 5 cases, forearm free skin flaps in 5 cases, and anterolateral thigh free skin flaps in 3 cases. Results The postoperative pathological results showed 10 cases of cervical lymph node metastasis; 2 cases had local recurrence and 3 cases had cervical lymph node metastasis after postoperative radiotherapy. Neck infection occurred at 5 days after operation in 1 case undergoing transplantation of pectoralis major myocutaneous flap, and vascular crisis occurred at 12 hours after operation in 1 case undergoing transplantation of forearm free skin flap, which were cured after correspondent treatments. The other flaps survived with incision healing by first intention. Second suture was carried out in 1 case undergoing anterolateral thigh free skin flap transplantation because of wound disruption at the donor site. All the patients were followed up 1 to 6 years, with an average of 3.6 years. In 5 cases undergoing pectoralis major myocutaneous flap transplantation, swallowing obstruction and stomatolalia occurred. In 8 cases undergoing free skin flaps transplantation, the appearances of the flaps and the functions of swallowing or speaking were satisfactory, with no dysfunction at the donor site. All the patients returned to normal occlusion, facial appearance and function were normal. According to the direct calculation method, the three-year survival rate was 60.0% (6/10), and five-year survival rate was 37.5% (3/8). Conclusion For the patients with advanced-stage tonsillar cancer, forearm free skin flaps, or anterolateral thigh free skin flaps is the first choice for repairing defect. However, it is better to choose pectoralis major myocutaneous flaps in patients who need large flap and fail to radiotherapy.
Objective To review the recent progress of the small intestinal submucosa (SIS) in application research of tissue repair and reconstruction. Methods The domestic and international articles on the SIS were reviewed and summarized. Results As a natural extracellular matrix, SIS has outstanding biological advantages, such as good mechanical property, tissue compatibility, and lower immunogenicity. SIS has been used to repair and reconstruct various types of tissue defects in animal models and clinical application, especially in the treatment of hernia, urinary system disease, and refractory skin trauma. The development of the tissue engineering technology expands the field of SIS repair and reconstruction and promotes the intensive study of SIS. However, the long-term effect of SIS in tissue repair and reconstruction still remains to be further observation, while the cell/SIS material construction by tissue engineering technology also needs more studies. Conclusion SIS has a widely promising application future in the tissue repair and reconstruction.
Objective To investigate the effectiveness of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction combined with l imited open repair of medial collateral ligament (MCL) in recovering the stabil ity and the function of the knee. Methods Between April 2003 and October 2010, 14 patients (14 knees) with multi ple injuries of ACL, PCL, and MCL were treated. There were 10 males and 4 females with an average age of 41 years (range, 21- 71 years). Injury was caused by traffic accident in 11 cases and fall ing in 3 cases. The average time from injury to admissionwas 2 days (range, 1-4 days). Lysholm score was 17.00 ± 8.29, and the International Knee Documentation Committee (IKDC) score was 20.93 ± 8.28. The complicated injuries included dislocation of the knee joint in 9 cases and meniscus injury in 5 cases. Allogeneic tendons (2 cases) and autologous harmstring tendon (12 cases) were used to reconstruct ACL and PCL under arthroscopy, and all cases underwent limited open repair of MCL. Results All incisions healed by first intention. Numbness of the lower limb occurred in 3 cases and alleviated spontaneously. All patients were followed up 14 months on average (range, 12-18 months). The knee flexion was 120° and extension was 0° at 3 months of follow-up. After 1 year of follow-up, IKDC score and Lysholm score were 89.93 ± 6.26 and 88.93 ± 4.82, respectively, showing significant differences when compared with preoperative scores (P lt; 0.01). Conclusion For multi ple injuries of the knee ligaments, an arthroscope with limited open repair and reconstruction of the knee ligament can avoid open joint chamber, reduce postoperative articular adhesion, and encourage the joint function recovery.
Objective To explore an improved method of surgical operation for redintegration of the articular surface and alignment with type III Pilon fractures. Methods Between August 2005 and August 2010, 31 patiens with closed type III Pilon fracture (Rüedi-Allgouml;wer type III) were treated. There were 25 males and 6 females, aged 36.8 years on average (range, 16-60 years). The injury was caused by falling from height in 18 patients, by traffic accident in 10 patients, and by other reasons in 3 patients. The average time between injury and operation was 10 days (range, 6-14 days). Temporary external fixation was used for adjustment and maintenance of limb length and power lines; application of fibular flip combined with anteromedial approach was used for the repair of articular surface; and bone grafting and fixation were performed. Results No extensive necrosis or deep infection were observed. Superficial skin infection of incision and wound edge necrosis occurred in 2 cases respectively, and were cured after dressing change. All patients were followed up 26 months on average (range, 9-79 months). According to the Burwell et al. judging standards of radiology evaluating, the anatomical reduction was found in 25 cases (80.6%), satisfactory reduction in 4 cases (12.9%), and unsatisfactory reduction in 2 cases (6.5%). The X-ray films showed bony healing was achieved in all cases with an average fracture healing time of 16 weeks (range, 12-25 weeks). According to the Mazur et al. criterion for ankle joint function, excellent result was obtained in 11 cases, good in 13, fair in 5, and poor in 2; the excellent and good rate was 77.4%. Conclusion Good exposure and fixation of articular surface or accurate adjustments and maintenance of the limb alignment are key factors of successful operation to treat type III Pilon fractures.
Objective To summarize the effect of free skin graft for repairing scrotal avulsion injury, and to investigate the repair impact of the method on spermatogenesis. Methods Between June 2001 and June 2010, 8 cases of complete avulsion injury of the scrotal skin were treated with the free skin graft, aged 22 to 64 years (mean, 29 years). The causes of injury included machine twisting in 4 cases, animal attack in 3 cases, and traffic accident in 1 case. The time between injury and hospital ization was 1-7 hours (mean, 3.5 hours). Five cases compl icated by avulsion of penile skin, 3 by perineal lacerationwith exposure of testes and spermatic cord, and 1 by avulsion of leg skin. Results After 10 days, 80% to 95% grafted skinsurvived. The reconstructed scrotum had shrinks and the wound healed by first intention after dressing change. Eight patients were followed up 12 to 24 months (mean, 16 months). At last follow-up, the patients had relaxed and droop scrotum, and penile erection was normal. Semen qual ity analysis showed: semen volume of 2-6 mL (mean, 4.2 mL); complete l iquefaction with l iquefaction time of 15-30 minutes (mean, 23 minutes); sperm density of (12-27) × 106/mL (mean, 16 × 106/mL); sperm motil ity of 45%-65% (mean, 56%); and sperm motil ity (grade A) of 25%-42% (mean, 32%). Conclusion Complete avulsion of the scrotal skin can be repaired by free skin graft, which has no significant effect on spermatogenesis.