ObjectiveTo review the application and research progress of in vivo bioreactor as vascularization strategies in bone tissue engineering. MethodsThe original articles about in vivo bioreactor that can enhance vascularization of tissue engineered bone were extensively reviewed and analyzed. ResultsThe in vivo bioreactor can be created by periosteum, muscle, muscularis membrane, and fascia flap as well as biomaterials. Using in vivo bioreactor can effectively promote the establishment of a microcirculation in the tissue engineered bones, especially for large bone defects. However, main correlative researches, currently, are focused on animal experiments, more clinical trials will be carried out in the future. ConclusionWith the rapid development of related technologies of bone tissue engineering, the use of in vivo bioreactor will to a large extent solve the bottleneck limitations and has the potential values for clinical application.
ObjectiveTo investigate the risk factors of skin necrosis around incision after total knee arthroplasty (TKA),and explore the measures of prevention and treatment. MethodsBetween June 2007 and June 2013,7 patients with skin necrosis around incision after TKA were treated.There were 5 males and 2 females with an average age of 69 years (range,59-78 years),including osteoarthritis in 4 cases,traumatic arthritis in 2 cases,and rheumatoid arthritis in 1 case.Two cases complicated by diabetes,and 2 cases by hypertension; 1 case received long-term hormone therapy; and 2 cases had a history of smoking.Scar was seen near knee joint in 2 cases.The skin necrosis ranged from 10 cm×2 cm to 13 cm×8 cm.The time from TKA to debridement was 7-15 days (mean,12 days).After thorough debridement,the saphenous artery skin flap,medial head of gastrocnemius muscle flap,lateral head of gastrocnemius muscle flap were used in 4 cases,2 cases,and 1 case respectively; reconstruction of patellar ligament was performed in 2 cases.Donor sites were repaired by split-thickness skin graft. ResultsAll the flaps and myocutaneous flaps survived well,and all wounds healed by first intention.At donor site,the grafted skins survived and wounds healed by first intention.No early complication occurred.All cases were followed up 6-12 months (mean,7.8 months).The flaps and myocutaneous flaps had good texture and appearance; no prosthetic loosening and displacement happened,no secondary infection was observed after operation.The knee range of motion was 45-110° (mean,85°) at 6 months after operation.According to the Knee Society Score (KSS),the results were excellent in 3 cases,good in 2 cases,general in 1 case,and poor in 1 case at 6 months after operation. ConclusionEarly discovery,thoroughly debridement,and timely repair with axial pattern flap or myocutaneous flap are the key factors to treat skin necrosis around incision after TKA and save the artificial prosthesis.
ObjectiveTo investigate clinical outcomes and prognostic factors of surgical resection of pulmonary metastases after esophagectomy. MethodsClinical data of 15 patients who underwent surgical resection of pulmonary metastases after esophagectomy from March 1994 to May 2008 were retrospectively analyzed. There were 10 males and 5 females with their age of 43-72 (65.0±8.8) years. Surgical procedures included partial lung resection, pulmonary wedge resection, segmental resection and lobectomy. Follow-up duration was 60 months after surgical resection of pulmonary metastases. The influence of number and size of pulmonary metastases, TNM staging of primary esophageal cancer, and disease-free interval (DFI) after esophagectomy on postoperative survival rate after pulmonary metastasectomy was analyzed. ResultsTwelve, 24 and 60 months survival rates after pulmonary metastasectomy were 80.0%, 66.7% and 6.7%, respec-tively. Median DFI was 30 months. Survival rate after pulmonary metastasectomy of patients whose DFI was longer than 24 months was significantly longer than that of patients whose DFI was shorter than 24 months (χ2=5.144, P=0.023). Survival rate after pulmonary metastasectomy of patients with solitary pulmonary metastasis was significantly longer than that of patients with multiple pulmonary metastases (χ2=3.990, P=0.046).The size of pulmonary metastases and TNM staging of primary esophageal cancer didn't have significant impact on survival rate after pulmonary metastasectomy (P > 0.05). Cox proportional hazards model showed that DFI after esophagectomy was the main factor affecting survival rate after pulmonary metastasectomy (P=0.026). ConclusionSurgical resection is a therapeutic strategy for the treatment of pulmonary metas-tases after esophagectomy, and may achieve good clinical outcomes for patients with solitary pulmonary metastasis and patients whose DFI is longer than 24 months.