Objective To explore the clinical effect of latissimus dorsi musculocutaneous flap with a few muscle in repairing the soft tissue defect of lower limbs. Methods From June 2000 to December 2006, 8 patients with soft tissue defects of lower limbs were repaired with the latissimus dorsi musculocutaneous flaps. There were 6 males and 2 females, aged from 2569 years. The locations were heel in 3 cases, dorsum pedis in 2 cases, anticnemion in 2 cases, and the right leg (squamous carcinoma) in 1 case. The area of soft defect ranged from 10 cm×7 cm～18 cm×12 cm. The flap in size ranged from 15 cm×8 cm to 22 cm×15 cm. Results Of all the flaps,6 survived,1 had vascular necrosis 2 hours after operation and survived by skin grafts, 1 had delayed healing because of infection. The wound and donor site achieved primary healing. The followup for 3 to 12 months revealed that all the flaps had a good appearance. The function of donor site was as normal. Conclusion It is an ideal method to repair the softtissue defect of lower limbs with latissimus dorsi musculocutaneous flap.
Objective To observe an early result after the repair of the large upper thoracic wall defect by a combined use of the titaniumnet, reconstruction nickelclad, and latissimus dorsi myocutaneous flap in a patient who underwent a breast sarcomatoid caricinoma resection on the upper thoracic wall. Methods A breast sarcomatoid carcinoma in the upper thoracic wall was removed in 1 56yearold female patient in February 2006. After the tumorectomy, a large thoracic wall defect was left, which was 20cm×15cm in size. The defect was covered by the titanium net, the bilateral stumps of the clavicles were connected by the reconstruction nickelclad, and the soft tissue defect was repaired with the right latissimus dorsi myocutaneous flap(20cm×15cm). Results The patient depended on the breathing machine for 3 days after operation. When the breathing machine was discontinued, the patient developed a severe paradoxical breathing. Two weeks after operation when theblood circulation of the flap was stabilized, the paradoxical breathing disappeared with the help of the chest bandage for fixation of the chest cavity, and the blood supply of the flap was improved. The chest X-ray film showed that the titanium net and the reconstruction nickelclad were well positioned. The patient received chemotherapy 1 month after operation, The follow-up for 3 months revealed that the patient’s local condition and physical condition were good, and ROMof both the shoulders was improved, with AF 90° and ABD 90°. No recurrence ofthe tumor was found. Conclusion A large thoracic wall defect should be repaired with solid materials. The normal anatomic locations of the clavicles should be maintained with fixation by the reconstruction nickelclad for a good function of the shoulders. The latissimus dorsi myocutaneous flap can be properly enlarged.
Objective To investigate whether the implanted myoblasts with the soluble carriers can improve the repairing efficiency for theseverelycryodamaged tibialis anterior muscles. Methods The skeletal myoblasts were isolated from the newborn SD rats by the use of the enzyme digestion. They were purified and serially subcultivated; the subcultivated myoblasts of the 3rd generation were marked with BrdU. The severelycryodamaged tibialis anterior muscle models were established from 84 SD rats aged 5 months. They were randomly divided into 4 groups, including Group A1 (the implanted myoblasts with the carriersF12 containing 0.1% sodium hyaluronate), Group A2 (the implanted myoblasts, with the carriersF12 that did not contain 0.1% sodiumhyaluronate), Group B1 (the implanted carrier solution containing 0.1% sodium hyaluronate, but with no myoblasts), and Group B2 (with no carrier solution or myoblasts). Six rats were killed at the following time points: at 2, 5 and 9 days,and 2, 4, 8 and 12 weeks after operation; the immunohistochemical and the Mallory staining studies were performed for an evaluation on the repairing efficiencyfor the severelycryodamaged tibialis anterior muscles. By the imaging analysis, the number of the survived cells in each group was compared at 2 days, and the area ratio of the collagen fiber in each group was also compared at 8 weeks. Results The BrdU immunohistochemical staining showed that the number of the remaining implanted cells was significantly greater in Groups A1 than in Group A2, the migrating area of the myoblasts was greater, the distribution of the cells was more uniform, the cell differentiating potential was undestroyed, the repairing efficiency for the severelycryodamaged tibialis anterior muscles was significantly improved. There was no bluestained nucleus at each time point in Group B. The Mallory staining showed that the fibrous degeneration inthe tissue repairing process was significantly inhibited in Groups A1, A2 and B1; the inhibition was most obvious in Group A1, and next in Group A2. The imaging analysis indicated that at 2 days after operation, the number of the survived cells was significantly-greater in Group A1 than in Group A2 (Plt;0.05). At 8 weeks after operation, the collagen fiber was the least in Group A1, less in Group A2, more in Group B1,and the most in Group B2 (Plt;0.05). Conclusion The implanted myoblasts can significantly improve the repairing efficiency for the severelycryodamaged muscle tissues, and the implanted carrier solution containing 0.1% sodium hyaluronate can improve the implanting efficiency for the myoblasts.
Objective To introduce the experience and comprehensionto reconstruct nasal defect after tumor excision. Methods FromApril 1996 to April 2006, based on the aesthetic subunit principle and according to the size, shape, location of nasal defect and the conditions of surrounding skin, homologous local flap was selected to cover the nasal defect in 428 cases which nasal tumors were removed. Among 428 cases, there were 273 men and 155 women, with a median age of 52 years (12-78 years); including 146 cases of basal cell carcinoma, 83 cases of squamous cell carcinoma, 54 cases of epidermal cyst, and 145 cases of pigmented naevus.The clinical stage of malignant tumor was 0-Ⅰstage, the course of disease was 1 week to 3 months. The locations were nasal tip in 51 cases, nasal ala in 102 cases, dorsum of nose in 138 cases, and nasal side in 137 cases, across 2 nasal subunits in 83 cases. The area of thedefect ranged between 0.6 cm×0.6 cm and 3.0 cm×4.0 cm. The origin of flaps was frontonasal flap in 58 cases, bilobed flap in 67 cases, reforming rhomboid flap in 152 cases, nasolabial flap in 118 cses, forehead falp in 33 cases. The secondary defect of donor site was directly sutured. Results Among 428 cases, 423 cases acquired complete recovery; 3 cases which had epiderm necrosis over the far end of the flap achieved healing by the first intention and 2 cases which had suffered low-grade infection of incision achieved healing by the second intention after regional change dressings.The nasal defect was successfully repaired in all patients,and the all flaps survived. A total of 385 patients were available forfollow-up of 1 to 60 months, no tumor recurrence occurred, and the repaired tissue were good match with surrounding tissue, good nasal contour was obtained, the cosmetic results were satisfactory. Conclusion Based on the nasal aesthetic subunit principle, the local flap can reconstruct the nasal above medial defect, and a good color, contour and texture match with the surrounding skin can be obtained, the cosmetic results are satisfactory.
Objective To investigate a suitable way to reconstruct scar constractures in the axilla and chest.Methods From January 2001 to December 2005, 52 patients(57 episodes) with scar constractures in the axilla and chest were treated, including 31 males and 21 females with an age range of 1-44 years.The deformities of scar constractures in the axilla and chest were reconstructed with posterior part of axillary scar skin flaps(44 epidsodes), anterior part of axillary scar skinflaps(10 episodes) and lateral part of upper arm’s scar skin flaps(3 episodes).The flaps were sutured to the surrounding tissues in 19 episodes, the donor sites in other38cases were covered with split thickness skin grafts. Results Fifty-four scar skin flaps survived completely by the first intention except 3flaps, which margin necrosed and healed with dressing changes. All patients were followed up 1 month to 5 years. All patients gained a good functional recovery and cosmetic appearance after the operation, and the unfolding function ofshoulder restored to 150°. Conclusion Axillary local scar skin flap is a good alternative method to reconstruct scar constractures in the axilla and chest.
Objective To investigate the clinical application and complicationof the lyophilized small-segment allogeneic bone used in repairing bone defectscaused by benign bone tumor and tumor-like lesions after resection and curettage. Methods From December 1999 to December 2005, 230 patients (156 males, 74 females; age, 5-56years, averaged 32.8 years), who had bone defects caused by benign bone tumors and tumor-like lesions after surgical resection and curettage, were treated by the lyophilized small-segment allogeneic bones. The cavities left by the tumor curettage ranged in size from 1.0 cm×0.8 cm to 10.0 cm×2.0 cm, andthe bone defects were about 1.0 to 3.5 cm in diameter after the localized resection of the bones. According to the bone defect degrees, the autogenous nonvascular iliac bone and the bone allograft (0.5-30.0 g) were implanted, followed by the drainage for 2-3 days and the use of antibiotics to prevent infection. The postoperative systemic and local reactions were observed, and the regular X-ray examinations were performed to observe the bone union. ResultsThere was no significant difference in the allergic reactions, such as postoperative temperature, drained amount, and body swelling, between this kind of transplantation and the autogenous bonetransplantation. The wounds in 196 patients were healed by the first intension.The wounds in 34 patients had extravasate. Among them, the wound was healed by changing dressing in 30cases; the wound had delayed healing in 4, including 3 whose wounds were healedby changing dressing for 3-4 weeks,and 1 whose wound was healed by taking out the implants. The follow-up for 6-60 months (average, 38 months) revealed that all the patients had the allograft unions of the bones within 6-18 months after the transplantation, and only 6patients had recurrence of the tumor (3.0%). Evaluated by the Mankin,Komender and WANG Zhiqiang’s standards, 196 (85.22%) patients were satisfied with their outcomes while the other 34 (14.78%) patients were not satisfied. Conclusion The lyophilized small-segment allogeneic bone has a good compatibility and osteogenesis, when it is used in repairing bone defects caused by benign bone tumor and tumor-like lesions after resection and curettage. So, this kind of bone is a good, convenient and safe material for the bone transplantation. The important factors affecting the allograft union are as follows: the mechanical stability in the recipient region, local blood supply, and management of the bone cavity left by resection and curettage of the bone tumor.