Objective To study the surgical method to reduce bleeding in treating hemangioma at non-limb sites. Methods From November 1998 to November 2003,49 cases of non-limb hemangioma were treated, aged 3 months to 63 years, including 21 males and 28 females. There were 14 cases of capillary hemangioma, 25 cases of cavernous hemangioma, 7 cases of arterial racemose angioma and 3 cases of mixture hemangioma. According to the position and type of hemangioma, the various methods of blocking blood vessels were adopted to assist resect tumors. Afterthe pulsatile artery was felt in arterial racemose angioma of neck and face by palpation, we sutured and knotted it with 7-0 silk string to block the bleeding.We found out the common iliac artery or external iliac artery or femoral arteryand blocked them temporarily to resect arterial racemose angioma in inguen and thigh. We sutured and knotted vessel with 7-0 silk string to block the bleedingin capillary hemangioma and cavernous hemangioma of neck and face and truncus. Results Intraoperative bleeding obviously decreased and the tumor size reducedto various extent. Of the 49 cases, 47 cases achieved complete success, 2 casesbled within two days after operation. A postoperative follow-up of 6 months to4 years showed that the appearance and function were satisfactory. Conclusion The preoperative method of blocking blood vessels obviously can reduce intraoperative bleeding and decrease operative difficulty, which makes it possible to eradicate hemangioma and lower recurrence rate.
From March 1979 to February 1987, 500 cases of firearm wounds of blood vessels were treated. Of them, 465 cases were recovered, 15 cases were disabled, 13 cases had amputation, and 7 cases died. The article presented the clinic materials. The following problems were discussed: (1) The characteristics of firearm wounds of blood vessels. (2) Emergency treatment of injuries of major blood vessels of limbs. (3) Indications of repair of blood vessels. (4) The methods of repair of defect in blood vessel. (5)Factors influencing the survival of extremities, and (6) Active prevention and treatment of complication.
Standard venographies were pcrformed to evaluate the endothelial damage by the contrast medium. After different time intervals, the local veins were prepared for transmission and scanning electron microscopy (TEM and SEM) investigation. The veins were in a dilated state after the angiographies, which lasted for about two days. The endothelial damage was most severe 1 day after the venography. Besides the lesions of extensive endothelial tissurs, dcsquamations, and the exposure of subendothelial tissues, microthrombi somethimes were found. Healing occurred within 3 days. The results this study has also verifieed that it was more valuable to study venogqaphic effects on veins with TEM and SEM.
Objective To establish a scaffold model from heterogeneoussmall blood vessels. Methods Caudal arteries from 34 Wistar rats( average length 12.08±1.69 cm) were made into acellular blood vessel scaffolds. Some scaffoldswere observed by electron microscope, and others were transplanted to the cut ends of ear central arteries of male Japanese big ear white rabbits. Results Average external diameter was 0.74±0.08 mm in proximal, and 0.55±0.08 mm in distal end of rat caudal arteries. The small blood vessel scaffolds had shin wall whichwas white and soft, composed of fibrous tissues without cells. On the intima surface the fibrous tissues were arrayed densely in a grid-like pattern. After transplantation, the blood flow was reserved, and kept flowing freely in 24 hours. The pulsation of the transplanted artery was accessible and no blood leakage wasfound.Conclusion The natural scaffolds are composed of fibrous tissues, and can sustain the artery pulse pressure for 24 hours. It is better to suture the blood vessels by sleeve anastomosis.
The experience on management of abnormal blood vessels in 128 cases of donor kidney during the tailoring operation was reported. The various techniques used for different types of abnormal arteries and veins, and the critical points which should be paid attention to have been discussed. It was concluded that the multiple renal arteries should be treated in a single renal artery and anastomosed with internal iliac artery or/and external iliac artery. The appropriate management given to abnormal renal blood vessels during the tailoring operation may shorten the warm ishemia time, ensure the renal blood supply, reduce the renal vasular complication, and promote the recovery of renal function.
Objective To develop an experimental model of abdominal aorta transplantation with nano-biomimetictissue engineered blood vessel (NBTEBV) and to investige the change of histomorphology in evolutionary process of degradation and remodel ing. Methods Twenty 6-month-old New Zealand rabbits were included, weighing 2-3 kg, male or female. The autologous seed cells of rabbits were harvested to build NBTEBV in vitro. After the branch of abdominal aorta under kidney was l igated, about 10 mm abdominal aorta was cut and replaced by NBTEBV; the anastomotic stoma was marked by Ti cl ips. NBTEBV’s evolutionary processes of degradation and rebuilding were observed. Twelve weeks after operation, DSA and color Doppler examinations were made. At 1, 4 and 12 weeks after operation, the gross and histological observations were made and 14C binding in PLGA was detected with X-ray photon spectroscopy. Results Of 20 rabbits, 17 showed that the NBTEBV was patency; 3 died from NBTEBV occlusion 36 or 72 hours after operation. The results of DAS and color Doppler showed the blood flow was patency, the blood flow rate was normal and there was no angiectasis. The lumen of transplanted blood vessel was covered with monolayer endothel ial cells. At 1 week, smooth muscle cells (SMCs) arranged regularly and much PLGA distributed in the EMCs. At 4 weeks, SMCs arranged in a layer, ECM was forming, mimic ECM degraded partly; PLGA decreased obviously. At 12 weeks, the SMCs arranged regularly, ECM formed, mimic ECM degraded, no PLGA was seen in the wall, the shape of graft was similar to the natural vessel. The decreasing crest value of 14C in specimen showed the degradation of PLGA. Conclusion NBTEBV has a good surgical maneuverabil ity and histocompatibil ity, its remodel ing evolutionary process fits in with tissue engineering specification. Building NBTEBV with ELSP is feasible.
ObjectiveTo explore the clinical application of the flap supported by perforating branch of the radial artery superior wrist catena-form blood vessel in repairing hand and wrist wound. MethodsBetween March 2010 and March 2013, 24 cases of severe wounds in wrist were repaired with the flap supported by perforating branch of forearm radial artery and catena-form blood vessel. There were 15 males and 9 females, aged 19-54 years (mean, 37 years). In 22 patients with trauma, there were 9 cases of machine injury, 5 cases of traffic accident injury, 5 cases of crash injury of heavy objects, 1 case of sharp instrument injury, and 2 cases of electrical injury, with a mean disease duration of 11 days (range, 2-20 days). In 2 patients with tumor excision wound, there were 1 case of right forearm liposarcoma and 1 case of left forearm squamous-cell carcinoma, with the disease duration of 7 days and 3 months, respectively. All cases complicated by bone and tendon exposure. The size of defect was 4.5 cm×4.0 cm to 10.0 cm×7.5 cm, and the size of the flap was 6.0 cm×4.0 cm to 20.0 cm×8.5 cm. The donor site was directly sutured or repaired by skin graft. ResultsPartial flap necrosis occurred in 1 case, and was cured after dressing change; the other flaps survived, and primary healing of incision was obtained. The patients were followed up 6-36 months (mean, 20 months). The flap featured good color and texture, and also recovered protective sensation at 6 months after operation, with a mean two-point discrimination of 12 mm (range, 11-14 mm). No ulcers of the flap was observed. At last follow-up, according to Hand Surgery Society of Chinese Medical Association for functional evaluation of upper limb, the function was rated as excellent in 19 cases, good in 4 cases, and fair in 1 case. ConclusionThe flap supported by perforating branch of forearm radial artery and catena-form blood vessel can be used to repair wound in wrist, which has no injury to the radial artery, and it also could be used for the patients with ulnar and radial artery injuries. Thus it is an ideal method to repair wound in the wrist because the operation is simple, and the flap has good appearance and texture.
Objective To investigate the clinical application of fistulation of artery and vein with self-blood vessel transplantation. Methods Seven patients with renal failure were given antebrachial fistulation of artery and veinwith great saphenous veins of themselves. The ortho- and pachy-great saphenous vein was chosed after it was cut. The great saphenous vein was passed bridge inside forearm in straight line or morpha-U. The method was anastomosis of the radial artery or brachial artery and cephalic vein, basilic vein or median cubital vein. Results The fistulations of artery and vein were successfuland all patients were in hemodialysis regularly. Conclusion The fistulation of artery andvein with selfblood vessel transplantation is a convenient, easy, cheap operation. It can coincide with the clinical demand and be used to make up the failureof fistulation or the fistulation that there is no blood vessel in the forearm.
Since Oct. 1990, the 2nd metatarso-phalangeal joint and big-toe nail composite graft with the neuro-vascular bundle was transplanted to reconstruct the thumb in 4 cases. The transplants were all survived. The follow-up through 5 months, a comparatively good function and appearance were achieved.The applied anatomy, the surgical technique and the matters needing attention were detailed.
Objective To repair defects at both ends of theblood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities by phleboplasty of branched and double autogenous veins. Methods Three kinds of phleboplasties——funnel-shaped, raincape-shaped and transposed Y-shaped were designed. Experiments in fresh blood vessels in vitro were completed successfully. These methods were used clinically to repair injured external iliac veins, femoral arteries and veins, and popliteal arteries and veins, to replant severed fingers and to transplant toenail flaps on thumbs by harvesting autogenous great saphenous veins,small saphenous veins and forearm veins in 36 cases, including 35 cases in emergency operation and 1 case in selective operation.The length of grafted blood vessels ranged from 1.0 cm to 15.0 cm. Results The phleboplasties of funnel-shaped could enlarge the diameter by 1.0-1.25 times inanastomotic stomas. The phleboplasty of raincape-shaped could enlarge the diameter large enough to meet the demands for various blood vessels in extremities. The phleboplasty of transposed Y-shaped could provide large vein transplants. In36 grafted veins, 35 were in patency. The blood supply in extremities was normal.ConclusionThe funnel-shaped and raincape-shaped phleboplasties of branched veins can enlarge the anastomotic stomas of grafted veins. The transposed Y-shaped phleboplasty of double femoral veins is an ideal way to repair injured primaryblood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities.