Objective To study the feasibil ity of repairing the mild unilateral eclabium deformity of the upper l ip with the lateral columella base-labrum transposition flap. Methods From March 2006 to March 2008, 8 patients with mild unilateral eclabium of the upper l i p were repaired with the lateral columella base-labrum transposition flap. There were 4 males and 4 females, aging 18-51 years. There were 5 at left sides and 3 at right sides. All mild unilateral eclabium were attributed to the contracture of scar after trauma. The disease course was 1 to 5 years (average 2.5 years). The size ofthe transposition flaps ranged from 1.5 cm × 1.4 cm to 1.6 cm × 1.5 cm. Results All the flaps survived and incision healed by first intention. The eclabiun deformity was corrected. The postoperative follow-up period was 3-18 months with an average of 9.9 months. All the patients remained just soft l inear scars without hyperplasia. The nostril and columella hardly changed compared with the postoperative immediate view. Conclusion The mild unilateral eclabium deformity of upper l i p repairing with lateral columella base-labrum transposition flap is an easy, mininally invasive and nearly no secondary malformation method.
【Abstract】 Objective To explore a method to identify the sensory and motor fascicles in peri pheral nervetrunk. Methods Thirty Wistar rats were selected to obtain whole spine. The spinal gangl ion, its dorsal root and ventral root,and sciatic nerve were harvested, Annexin V and Agrin specificities were observed with Western blot. In the experimental group,anterior branch and posterior branch of spinal nerve, sciatic nerve, and its muscular branch and cutaneous branch were harvested from 15 rats to make the observation of immunohistochemistry. In the other 15 rats, first antibody was replaced by PBS as control group. Different nerve fascicles were studied with Micro Raman scattering technique in 16 12-month-old New Zealand rabbits. Results The Annexin V and Agrin were special substances of sensory and motor nerves respectively and can act as specific antigens for identifying different nerve fascicles. There were significant differences in the intensity and breadth of the peak of the spectral properties between motor and sensory fascicles at frequencies of 1 088, 1 276, 1 439, 1 579 and 1 659 cm-1 .The peak intensity ratios of 1 276 to 1 439 cm-1 were 0.95±0.06 in motor nerve fascicles and 1.17±0.08 in sensory fascicles, showing significant differences (P lt; 0.05). Conclusion The Micro Raman spectra is more effective than immunohistochemistry in identifying different nerve fascicles, and it possesses as feasibil ity for cl inical appl ication.
Objective To evaluate the feasibil ity of direct anastomosis in the rat model of the brachial plexus extravertebral foramen nerve root division of C5-7. Methods Forty-eight SD rats (male or female) aging 4-6 months and weighing 250-300 g were selected to make the model of extravertebral foramen nerve root division of C5-7. The left C5-7 nerve roots, as the experimental sides, were separated to the brachial plexus nerve trunk and the transected roots were sutured to theproximal stump immediately after cutting off the brachial plexus extravertebral foramen nerve root division. The right C5-7nerve roots, as the control sides, received no operation. The general condition of rats after operation was observed. The gross observation, the histological observation and BDA nerve tracing technology were adopted to observe the wet weight of musculus biceps brachii, the cross section of biceps brachii and the spinal cord and distal nerve trunk at 3 weeks, 3 months and 6 months after operation. Results All rats survived well after operation. Claudication and unfold claw reflex were observed in the experimental sides, and the unfold claw reflex disappeared 3 months later. Comparatively, the control sides were normal. Nerve adhesion aggravated gradually and the neural stems were shriveled within 6 months after operation in the experimental sides. Comparatively, the control sides were normal. The wet weight of biceps brachii in the experimental sides and the control sides at 3 weeks, 3 months and 6 months after operation was (0.28 ± 0.12), (1.37 ± 0.33), (0.58 ± 0.10), (1.36 ± 0.35), (1.39 ± 0.31), (1.37 ± 0.38) g, respectively, indicating significant differences between two sides at 3 weeks and 3 months (P lt; 0.05), but no significant difference at 6 months (P gt; 0.05). The modified Marsland and the LFB staining of spinal cord and superior trunk of brachial plexus showed that the number of neurons, cell nuclear and Nissl body decreased and cell bodies changed from swell ing to shrinkage, dyeing nerve fibers increased, neural axone was thin and myel in sheath was sl ightly stained at each time point in experimental side. The number of motor neurons in cornu anterius medullae spinal is in the experimental side was 84.5% ± 3.2%, 74.4% ± 4.5%, 73.7% ± 3.8% of that in the control side at each time point, respectively. HE staining of biceps brachii detected thatthe muscle denaturation was very serious at 3 months after operation and then recovered. Neural tracing used BDA showed that the closer to the proximal of nerve trunk, the more obviously stained it was of myel in sheath and the more massive of axon at 6 months after operation. And there was almost no myel in and axon stained in musculocutaneous nerve. Conclusion In the rat model of brachial plexus extravertebral foramen nerve root division, the motoneuron in cornu anterius medullae spinal is necrosis rate reaches 20%-30%, and most of the residual neurons are pathologic. The regenerated fibers manifest as insufficient dynamic power and incomplete development, making no sense for the recovery of end organ function. Therefore, the exact mechanism of the recovery of biceps brachial muscle demands further study.
Objective To explore a suitable repairing method for skin defects of the foot and ankle, and to evaluate the therapeutic effects of the different repairing methods. Methods From January 2000 to October 2005, 36 patients with skin defects of the foot and ankle underwentthe repairing treatment, of whom 35 were males and 1 was female, aged 5-62 years, averaged 38 years. Of the 36 patients, 12 had an injury by a machine, 22 had a traffic accident, 1 had an infection, and 1 had a cold injury. And the injuries involved the dorsum of the foot, heel, forefoot, and medial or lateral malleolus. The injuries were respectively treated by 2 different repairing methods, the repair with the coverage by the lateral supramalleolar flaps and the repair with the coverage by the reverse sural neurocutaneous flaps. The skin defectsranged in area from 5 cm×4 cm to 20 cm×10 cm. The lateral supramalleolar flapwas used in 15 patients (15 flaps) with a flap area of 5 cm×4 cm-15 cm×8 cm,and the reverse sural neurocutaneous flap was used in 21 patients (22 flaps) with a flap area of 6 cm×4 cm20 cm×10 cm. We retrospectively observed the therapeutic results and compared the success rates of the two methods. Results Of the 36 patients, 15 underwent the repair with the coverage by 15 lateral supramalleolar flaps; 10 achieved a complete survival of the flaps, 2 developed an epidermal necrosis over the distal part, and 3 developed a complete necrosis.The other 21 patients underwent the repair with the coverage by 22 reverse sural neurocutaneous flaps. Of the 22 flaps, 21 had a complete survival, and only 1 failed to survive. The comparison revealed that there was no difference in the color, texture, and contour of the flaps between the 2 repaired groups. And the patients in the 2 groups were equally satisfied with the repairing treatments. The sensation of the flaps recovered to S0-S1. Conclusion The repairing of the foot and ankle skin defects with the coverage by the lateral supramalleolar flaps or by the reverse sural neurocutaneous flaps can achieve a similar good therapeutic result. However, the repair with the lateral supramalleolarflaps is more suitable for the skin defect of a smaller area over the medial orlateral malleolus, or the proximal dorsum of the foot; the repair with the reverse sural neurocutaneous flaps is more suitable for the skin defect of a larger area over the foot and ankle without serious destruction of the malleolar arterial rete.
Objective To demonstrate the anatomical and biomechanical basis of scaphoid ring sign in advanced Kienbock’s disease. Methods The study consisted of two sections. The ligaments stabilizing the proximal pole of the scaphoid were observed in 5 specimens. Under 12 kg dead weight load through the tendons of the flexion carpal radial, the flexion carpal ulnar, the extension carpal radial, and the extension carpal ulnar for 5 minutes, the stresses of the scaphoid fossa and lunate fossa were measured in the case of neutral, flexion, extension, radial deviation and ulnar deviation of the wrist joint under normal and rupture conditions respectively by FUJI prescale film and FPD-305E,306E.Results Based on anatomical study, the ligaments stabilizing the proximal pole of the scaphoid consisted of the radioscaphocapitate ligament, long radiolunate ligament and scapholunate interosseous ligament; and the latter two ligaments restricted dorsal subluxation of the proximalpole of the scaphoid. When compared rupture condition with normal condition, thescaphoid fassa stress of radial subregion was not significantly different (0.90±0.43 vs 0.85±0.15), and the ones of palmar, ulnar and dorsal subregions decreased (0.59±0.20, 0.52±0.05 and 0.58±0.23 vs 0.77±0.13, 0.75±0.08 and0.68±0.09) in the case of extension; the scaphoid fassa stresses of all subregions increased or had no difference in the case of neural, flexion, radial deviation and ulnar deviation. The lunate fossa stresses of all subregions increased in thecase of neural, and the ones of all subregions decreased or had no difference inthe case of flexion, extension, radial deviation and ulnar deviation.Conclusion Rotary scaphoid subluxation should be treated operatively at Ⅲ B stage of Kienbock’s disease to avoid traumatic arthritis of theradioscaphoid joint.
Objective To investigate the procedure and applications ofantegrade and retrograde dorsal metacarpal flaps with cutaneous branches as pedicles in repairing soft tissue defects of wrist and fingers. Methods From 1995 to 2003, we observed that the proximal and distal branches, deriving from the dorsal metacarpal artery, formed a consistent anastomosis arc subdermally. The anastomosis arc was paralleled to the dorsal metacarpal artery. Antegrade and retrograde dorsal metacarpal flaps could be designed using proximal anddistal branches as pedicles. Twenty-seven cases of soft tissue defects were treated by use of dorsal metacarpal flaps with cutaneous branches as pedicles, including 3 cases of defects on dorsum of hand with antegrade flaps, and 24 cases of defects on fingers with retrograde flaps ( index finger:12 cases; middle finger: 6 cases; ring finger: 4 cases; and little finger:2 cases). The dimensions of the antegrade flaps were 2.0 cm×4.0 cm～4.0 cm×6.0 cm, and the dimensions of theretrograde flaps were 2.5 cm×3.5 cm～3.0 cm×7.0 cm.The incision of the donor site was closed directly. Results All flaps survived. After a follow-up of 13 years, the texture and color of the flaps were good, and the shape and function of the donors were normal. Conclusion The antegrade or retrograde flap pedicled with the distal or proximal cutaneous branches of thedorsal metacarpal artery, is an optimal flap in repairing finger or wrist softtissue defects.
Objective To observe the plastic changes of sensory nerve in terms of structure and function when targetorgan changed through making the rat model of nerve regeneration by anastomosing the proximal end of sensory nerve and the distal end of motor nerve. Methods Thirty adult SD rats (male or female), weighing 200-250 g, were randomized into three groups (n=10 per group). The left upper l imb of the each rat was used as the experimental side, while the right upper l imb as the control side. In group A, the medial antebrachial cutaneous nerve was cut 5 mm away from its origin and its proximal end was anastomozed end-to-end to the distal end of musculocutaneous nerve. In group B, the musculocutaneous nerve was cut 5 mm away from its nerve entry point and the proximal end of medial antebrachial cutaneous nerve were anastomozed end-to-end to the distal end of musculocutaneous nerve. In group C, medial antebrachial cutaneous nerve and musculocutaneous nerve were cut, without further anastomosis. Twenty-four weeks after operation, the general condition and the motion of the elbow joint of rats, the wet weight and muscle fiber cross-section area of the biceps brachii as well as the latent period and the ampl itude of the evoked potential were observed and the acetylchol inesterase (AchE) staining of nerve of proximal end of anastomosis was conducted. Results All the rats survived for 24 weeks with good general condition and without wound infection. The rats in groups A, B and C were lost the active flexion of left elbow joint after operation. The rats in groups A and B got recovered to some degree at 24 weeks. The behavioral evaluation showed that there were 7 l imbs in group A and 5 l imbs in group B scoredas 4-5 points, there was a significant difference when compared with group C (P lt; 0.05), but there was no significant difference between group A and group B (P gt; 0.05). Group A and group B were superior to group C in terms of the wet weight and the muscle fiber cross-section area of the biceps brachii (P lt; 0.05), but no significant difference between group A and group B was detected (P gt; 0.05). The evoked potential of the biceps brachii and motor nerve fibers in proximal end of anastomosis could be detected in both group A and group B. But there was no significant difference between group A and group B with respects of function recovery of elbow joint, the latent period and the ampl itude of the evoked potential of the biceps brachii and the quantity of motor nerve fiber in proximal end of anastomosis (P gt; 0.05). Conclusion The change of target organ leads to the sensory nerve plasticity structurally and functionally, which may provide a new approach for peripheral nerve repair.
Objective To investigate the velvet antler polypeptide (VAP) on sciatic nerve regeneration in rats through local administration and VAP-PLGA compound membrane. Methods The 3, 15 mg/g of VAP-PLGA compound membranewere prepared by compounding VAP and PLGA, respectively. Seventy-two Wistar rats, male or female, aged 3-6 months and weighing (250 ± 50) g, were selected to make the model of sciatic nerve section. Then, all rats were randomized into 4 groups (n=18): group A in which nothing was given after anatomosis, group B in which 1 mL of VAP at the concentration of 10 mg/L was injected into the gastrocnemius muscle medial for every other day, group C in which 3 mg/g of VAP-PLGA compound membrane was given to the nerve anastomotic stoma and group D in which 15 mg/g of VAP-PLGA compound membrane was given to the nerve anastomotic stoma. The sciatic adhesion degree observation, electrophysiological examination, immunohistochemical staining and hemi-quantity calculation and horseradish peroxidase (HRP) retrograde tracing were conducted 2, 4 and 6 weeks after operation, respectively. Results All rats survived to the end of the experiment, without foot ulcer or neuroma. Severer nervous adherence was observed in group A, mild adherence in group B, and no adherence in groups C and D 2, 4 and 6 weeks after operation, respectively. The recovery rate of the evoked potential of triceps surae in groups B, C and D was better than that in group A (P lt; 0.01), group D was superior to groups B and C (P lt; 0.05) at each time point. No significant difference between group B and group C (P gt; 0.05) 2, 4 weeks after operation was detected, but group C was superior to group B (P lt; 0.05) 6 weeksafter operation. For the regenerative fiber axon and the expression of myelin sheath TGF-β1 and IGF antigen, the staining intensity in groups B, C and D was higher than that in group A at each time point (P lt; 0.05), and there were significant differences between group D and groups B and C 6 weeks after operation (P lt; 0.05), but no difference between groups B and C (P gt; 0.05). The HRP retrograde tracing showed that the myelinated nerve fiber stained by HRP gradually increased as time passed by and myelinated nerve fiber stained by HRP in groups B, C and D was much more than that in group A, and group D was superior to the other groups. No significant difference between group B and group C was detected. Conclusion To apply VAP through either local administration or VAP-PLGA compound membrane around the attached site of nerve anastomosis is capable of promoting nerve regeneration, which has an obvious dose-effect relationship with the dose of VAP. Meanwhile, VAP-PLGA compound membrane can prevent the nerve adhesion.
Objective To study the functional change of nerve trunk after removing the partial bundles of ulnar nerve, to propose the concept of functional reserve of peripheral nerves and to investigate the functional reserve quantity of peripheral nerves. Methods Two hundred and twenty SD rats (male or female), aging 3 months and weighing 300-350 g, were randomized into the experimental group and the control group (n=110 per group). And the experimental group wassubdivided into group 1/8, group 1/4, group 1/3, group 1/2 and group 2/3 according to the resection portion (n=22 per group). In the experimental group, the section of the lowest level on ulnar nerve trunks was exposed, and a certain portion of its bundles was separated and cut, while in the control group the bundles were only separated without resection. The general condition of all rats was observed, and the motoneurons in cornu anterius medullae spinal is were detected at 1 week, 2 weeks and 2 months after operation. The neuro-electrophysiology and the function of dominated muscles were detected at 2 weeks, 2 months, 3 months, and 4 months after operation. Results All the rats survived without infection and obvious ulcer in the l imbs. The number of motoneurons in cornu anterius medullae spinal is in various experimental subgroups witnessed no obvious changes (P gt; 0.05). The superstructure changed obviously at the early postoperative stage in group 1/2 and group 2/3, but restored well at 2 months after operation. For the latent period of evoked potential, there was no significant difference between the various experimental subgroups and the control group at each time point (P gt; 0.05), but there was a significant difference among the various experimental subgroups when compared the time points of 2, 3 and 4 months to that of 2 weeks (P lt; 0.05) and no statistically significant difference at other time points (P gt; 0.05). For the wave ampl itude of evoked potential of motor nerves, the maximum wave ampl itude and the persistence time of the dominate muscle, there were significant differences between the various experimental subgroups and the control group at each time point (P lt; 0.05), and there were significant differences among the various experimental subgroups when comparing the time points of 2, 3 and 4 months to that of 2 weeks (P lt; 0.05) and no statistical significance at other time points (Pgt; 0.05). Conclusion The functional reserve of the ulnar nerve withoutcompromise accounts the 1/3 of the whole trunk diameter.