To introduce a new technique for vascular pedicle elongation in the anterolateral thigh island flap transplantation and evaluate the outcome of this technique in the clinical application. Methods From January 2003 to January 2006, 6 patients (5 males, 1 female; age, 1849 years) were admitted for surgical operation because of the soft tissue defect around the knee joint. The soft tissue defect after the injury was found in 3 patients, the defect after the removal of the softtissue tumor in 1, and the defect after the prosthetic replacement in the knee joint in 2. The soft tissue defects ranged in size of 8 cm×4 cm to 15 cm ×6 cm. When the anterolateral island flap of the thigh underwent the reverse transplantation, the ascending branch of the lateral circumflex femoral artery was used as a nutrient vessel for the flap, and the descending branch of the lateral circumflex femoralartery was separated to the distal part. The main trunk of the lateral circumflex femoral artery was ligated at the point that was proximal to the furcation ofthe ascending and decending branches so that the vessel pedicle of the flap could be lengthened and then the defect was repaired.The flaps ranged in size of 10cm×6 cm to 18 cm×8 cm Results All the flaps were successfullytransferred in the 6 patients. The lengthened pedicle ranged in length from 8 to 12 cm, with an average of 10 cm. There was no vascular crisis after operation. All the transferred flaps survived, with a color and texture similar to those in the recipient site. The postoperative followup for 6-18 months revealed that the motion range of the knees was satisfactory. Conclusion The vascular pedicle elongation technique can enlarge the application scope of the anterolateral thigh island flap and the survival rate of the flap is not influenced by any factor.
Objective To observe the anatomic basis and the clinical application of the modified peroneal arterial cutaneous branch nutritional flap. Methods Twenty sides of lower limb of adult colyseptic cadavers and 5 sides of lower limb of adult fresh cadavers were used to detect the cutaneous branches of the peroneal artery. The position where the cutaneous branches come from the peroneal artery and the diameter of the cutaneous branches were recorded. From September 2003 to June 2005, 10 cases of skin and soft tissue defects in the region of metatarsophalangeal point with the modified peroneal arterial cutaneous branch nutritional flap, in which the cutaneous branches from the peroneal artery 11.0±1.7 cm upon the lateral malleolus were added. The defect size was 10 cm×6 cm to 15 cm×10 cm. The flap size was 11.0 cm×6.5 cm to 16.0 cm×11.0 cm. Results There is a stable cutaneous branches from peroneal artery 11.0±1.7 cm upon the lateral malleolus. The diameter of this cutaneous branches at the origin is 1.45±0.12 mm. The distance between the cutaneous branches entrance of the deep fascia and the line of the sural nerve nutritional artery flap was 15.70±1.20 mm. All 10 flaps survived. The blood supply and venous return of the skin flaps were good. The 10 patients were followed up from 6 to 12 months. The shape of the flaps was satisfactory. The texture and the color and luster of the flaps were similar to the adjacent skin. The functions of the feet were good. The twopoint discrimination was 1118 mm. Conclusion The modified peroneal arterial cutaneous branch nutritional flap has good blood supply. It can reverse to a long distance and can repair large skin defects.
Objective To research the effects of vascular endothelial growth factor (VEGF) on the survival of reverse flow axial skin flaps. Methods A 8 cm×2 cm full thickness transverse dorsal flap based on right deep circumflex iliacartery was elevated in 20 SpragueDawley rats, which length crossing midline was 4.0 cm. The rats were randomized into two groups:experimental group (n=10), subcutaneous VEGF injections into the flap (200 ng, 200 μl) after flap elevation; controlgroup (n=10), subcutaneous saline injections into the flap (200 μl) after flap elevation. The flap was immediately sutured to its recipient beds then the injection was executed. Seven days after operation, the survival area of flaps and density of vessels were observed and measured, meanwhile its histological representation of the flaps was examined. Results After 7 days of recovery, the mean survival area of flaps was 15.55±0.27 cm2 in experimental group and 13.42±0.57 cm2 in control group. The difference was significant between experimental group and control group (P＜0.01). The mean vessel density of flaps was 21.00±3.16 in control group and 34.40±3.75 in experimental group. The difference was significant between experimental group and control group (P＜0.01). Histological analysis demonstrated that a qualitatively greater amount of granulation tissue, regular collagen fiber and a lot of fibrillated cells were observed in experimental group. Erythrocytes were leaked outfrom vessels, and inflammatory cells were observed around in control group. Conclusion In early survival of flaps, the VEGF can improve the survival of areverse flow axial skin flap through improving angiogenesis and increasing the perfusion of vessel. It is an effective method of improving the survival of reverse flow axial skin flaps that VEGF is fully injected in subcutaneous flaps by single, when flaps are elevated.
Objective To investigate the effect of hypoxia on expressions of erythropoietin（EPO）mRNA and protein in retinal Muuml;ller cells cultured in vitro. Methods Retina tissues from the new-born Wistar rats were dissected into cell suspension after digested by pancreatin.Muuml;ller cells were separated and purified by mechanical concussion and blowing and striking method.The expression of EPO mRNA and protein under the condition of hypoxia was detected by semi-quantitative reverse transcriptase（RT）-polymerase chain reaction（PCR）and immunocytochemical method. Results Retinal Muuml;ller cells were cultured successfully，95% of which were positively stained by glial fibrillary acidic protein（GFAP）.Positively stained EPO protein was located in the cytoplasm and protuberance.The expression of EPO mRNA and protein was faint in the normal retinal Muuml;ller cells，but increased obviously and time-dependently after hypoxia. Conclusion Expression of EPO mRNA and protein increases in Muuml;ller cells after hypoxia，which may be one of the protective factors for the nerves in anoxic retinopathy. (Chin J Ocul Fundus Dis, 2006, 22: 196-199)
Objective To explore the effect of connective tissue growth factor on the pathogenesis of hypertrophic scar and keloid tissue. Methods The content of hydroxyproline was determined and the expression of connective tissue growth factor gene was detected by the reverse transcription-polymerase chain reaction and image analysis technique in 5 normal skins, 15 hypertrophic scars and 7 keloid tissues. Results The contents of hydroxyproline in the hypertrophic scar(84.10±1.76) and keloid tissue (92.38±2.04) were significantly higher than that of normal skin tissue (26.52 ± 4.10) (P lt; 0.01). The index of connective tissue growth factor mRNA in the hypertrophic scar (0.78 ± 0.63) and keloid tissue (0.84 ± 0.04) were higher than that of normal skin tissue ( 0.09 ± 0.25) (P lt; 0.01). Conclusion Connective tissue growth factor may play an important role in promoting the fibrotic process of hypertrophic scar and keloid tissue.
Objective To observe the survival rate of reversed-flow free flap after anastomosing one venous reverse flow and to explore the change of intravenous pressure and mechanism of venous reverse flow. Methods Thefree vascularized posterior tibial flap with reversed flow was successfully established in NewZealand white rabbits.Fifteen rabbits were randomly allocated into 3 groups of 30 flaps. In group A,two vena comitans were anastomosed.In groups B and C,only onevenae comitans was anastomosed. In groups A and B,intravenous pressure was measured immediately and 30,60 and 120 minutes after anastomosing the vascular pedicle.Flap survival rate of group B was measured after two weeks. In group C, radiography of one venae comitans was observed.The diameters of posterior tibial vessels was measured on all the rabbits before anastomosing the vascular pedicle. Results The diameters of posterior tibial artery was 8.0±0.3mm and of vena comitans was 11.0±0.5 mm。The intravenous pressure of group B increased rapidly and reached its top value after about 30 minutes (P＜0.05).It then decreased and approached normal level after about 60 minutes (Pgt;0.05).The intravenous pressure was not significantly different between groups A and B in each time interval (Pgt;0.05).Two flapsresulted in avulsion,infection and necrosis.The remaining 8 flaps survived completely.Most of the radiopaque in group C flew back to the proximal tibia one hourlater. Conclusion Venous retrograde return is abundant in reverseflow free flap of anatomosing one vena comitans.The main way of venous reflux in reverseflow free flap can be through “direct incompetent valve route”.
Objective To investigate the basic mechanism of venous flow in reverseflow island flap. Methods Recent relevant literature on the mechanism of venous reverse flow in reverseflow island flap wereextensively reviewed. Results The mechanism of venous reverse flow was a multifactorial phenomenon. “Communicating and collateral by pass route” and “incompetent valve route” were two theories. Conclusion The two routes of venous reverse flow in reverse-flow island flap coexistand complement each other.
Objective To evaluate the effectiveness and safety of intraoperative tranexamic acid use in total shoulder arthroplasty. Methods By searching Cochrane Library, PubMed, Embase, Chongqing VIP, Chinese National Knowledge Infrastructure, Wanfang Database from the establishment of the database to September 2021, randomized controlled trials of intraoperative tranexamic acid use in total shoulder arthroplasty were collected. Outcome indicators were total blood loss, postoperative drainage, hemoglobin reduction, length of operation, length of hospital stay, and formation of hematoma. RevMan 5.3 software was used for meta-analysis. Results Meta analysis results showed that the use of tranexamic acid can reduce total blood loss [weighted mean difference = −246.55 mL, 95% confidence interval (−335.36, −157.75) mL, P<0.000 01], reduce postoperative drainage [weighted mean difference = −134.05 mL, 95% confidence interval (−161.72, −106.38) mL, P<0.000 01], reduce hemoglobin reduction [weighted mean difference = −0.64 g/dL, 95% confidence interval (−0.91, −0.36) g/dL, P< 0.000 01], reduce hematoma formation [risk ratio=0.41, 95% confidence interval (0.22, 0.77), P=0.005]. There was no statistically significant difference in the length of operation and length of hospitalization between patients who used tranexamic acid and those who did not use tranexamic acid (P>0.05). Conclusions Tranexamic acid is effective and safe for patients undergoing total shoulder arthroplasty. It can reduce perioperative bleeding and hematoma formation without increasing the length of surgery and hospitalization.
Objective To detect the expression of forkhead box P3 （FOXP3 ）gene in esophageal squamous cell carcinoma(ESCC) and provide a new basis for immunotherapy of esophageal cancer. Methods Based on fluorescent TaqMan methodology, a realtime quantitative reverse transcription polymerase chain reaction (RT-PCR) for detecting the expression of FOXP3 was set up. In this method, a cloning vector pMD 18-T-FOXP3 was constructed as a standard plasmid. The specific expression of FOXP3 in 42 patients with ESCC and 30 healthy controls were measured by using GeneAmp 7500 Sequence Detection Systems. Results FOXP3 mRNA copy number in ESCC was significantly higher than that in healthy control tissue ［(72.20±23.10)×104copy/μg RNA vs.(0.68±0.34)×104 copy/μg RNA；Plt;0.05］. Conclusion A realtime quantitative RT-PCR method for detecting the expression of FOXP3 gene in ESCC has been successfully established. The expression level of FOXP3 is increased in ESCC compare with healthy controls.
Objective To evaluate the expressive varieties of Nogo-A mRNA in injured optic nerves of rats. Methods Reverse transcription polymerase chain reaction (RT-PCR) method was used to hemi-quantitatively analyze the levels of Nogo-A mRNA in the optic nerves 3, 7, 9, 15, 21, and 25 days respectively after injury.Results The level of the expression of Nogo-A mRNA was low in the normal optic nerves, while it was significantly high in the optic nerves 3 days after in jury, and kept the high level still after 25 days.Conclusion The expression of Nogo-A mRNA in injured optic nerves is increased. (Chin J Ocul Fundus Dis，2003，19：201-268)