Objective To compare two kinds of myofascial flap encapsulating adi pose-derived stromal cells (ADSCs) in adi pogenic efficacy in vivo, and to provide experimental basis for the efficient transplantation of free adi pose tissue. Methods ADSCs were isolated from the subcutaneous adipose tissue in the neck of 10 New Zealand rabbits (aged 3-4 months old, male and female, weighing 2.0-2.5 kg), and primary culture and subculture of ADSCs were conducted. When the cells at passage 3 covered 70%-80% of the bottom of the culture flask, BrdU (10 μg/mL) was appl ied to label the cells for 48 hours before performing immunofluorescence staining. Oil red O staining observation was conducted to thosecells 2 weeks after being induced towards adi pocyte, al izarin red staining observation was performed 3 weeks after being induced towards osteoblast, and alcian blue staining was conducted 2 weeks after being induced towards chondrocyte. Besides, after being induced towards adipocyte for 2 weeks, 1 × 107 ADSCs/piece at passage 3 labeled by BrdU was seeded into Col I (10 mm × 10 mm × 5 mm/piece) to prepare cell carrier complex. The experiment was divided into two groups: group A in which vascular pedicled dextral latissimus dorsi fascial flap was adopted to encapsulate the complex; group B in which dextral gluteus maximus fascial flap with no specific vessel pedicle was appl ied to encapsulate the complex. Rabbits in each group went through autogenous ADSCs transplant and self control. The implants were dislodged 8 weeks after operation, HE staining and immunohistochemistry staining were performed to testify cambium, the wet weight and micro vessel count of the cambium in each group were tested, immunofluorescence staining was performed to determine the origin of cambium and microvascular endothel ium. Results The nucleus of ADSCs positive for BrdU label ing showed green fluorescence under fluorescence microscope, with the positive label ing ratio of ADSCs above 90%. For ADSCs at passage 3, the formation of red l ipid droplets within cells was observed 2 weeks after being induced towards adipocyte, red calcium nodules were evident 3 weeks after being induced towards osteoblast, and highly congregated cell mass positive for alcian blue staining appeared 2 weeks after being induced towards chondrocyte. Eight weeks after operation, neogenetic blood vessel grew into scaffolds and no obvious fibreencapsulation was observed in group A, while few blood vessel grew into scaffolds in group B. The wet weight of cambium in group A and B was (0.149 5 ± 0.017 3) g and (0.095 3 ± 0.012 7) g, respectively, indicating there was a significant difference between two groups (P lt; 0.01). HE staining showed the formation of neogenetic adipose tissue and the growth of micrangium in the implant, and the degradation and absorption of scaffold. The micro vessel count of group A and B was 31.2 ± 4.5 and 19.3 ± 2.6, respectively, indicating there was a significant difference between two groups (P lt; 0.01). Eight weeks after operation, the immunofluorescence staining of cambium showed that the cell nucleus of regenerated adi pocytes and partial capillary endothel ium in groups A and B presented green fluorescence. Conclusion ADSCs encapsulated by vascular pedicled latissimus dorsi fascial flap and collagen protein scaffold complex has a higher adi pogenic efficacy in vivo than the gluteus maximus fascial flap with no specific vessel pedicle.
The noses of eight patients being dead for 2hours were dissected to investigate the layers andstructure of the nose, and the stability of theimplanted silicone noae prosthesis was tested.According to the structure and microstructure ofthe nose studied by us, we suggested a newconcept of nasal muscle and dorsal deepfasciacomplex. We confirmed the prcathesis should beimplanted in the space between the nasal boneand the complex. The reason for complicationhappened in this approach was that...
Objective To investigate the effect of free anterolateral thigh adipofascial flap in correcting the hemifacial atrophy. Methods From January 1997 to May 2006, 35 patients suffering from hemifacial atrophy were corrected with microvascular anastomotic free anterolateral thigh adipofascial flap and other additional measures according to the symptoms of the deformities. There were 11 males and 24 females, aging 1547 years. The locations were left in 12cases and right in 23 cases. The course of disease was 4 to 28 years. Their hemifacial deformities were fairly severity. Their cheeks were depressed obviously. The X-ray films and threedimensinal CT showed the 28 patients’ skeletons were dysplasia. The size of adipofascial flap ranged from 8 cm×7 cm to 20 cm×11 cm. Donor sites weresutured directly. Results Recipient site wound of all patients healed by first intention. All adipofascial flaps survived. The donor sites healed well and no adiponecrosis occurred. Thirty-five cases were followed up for 6 months to 8 years. The faces of all patients were symmetry, and the satisfactory results were obtained. There were no donor site dysfunction. Conclusion The anterolateral thigh adipofascial flapprovides adequate tissue, easytosurvive, no important artery sacrificed and the donor scar ismore easily hidden. Combining with other auxiliary methods, it can be successfully used to correct the deformity of hemifacial atrophy.
ObjectiveTo investigate the application and effectiveness of split-thickness scalp graft and temporoparietal fascia flap in the low hairline auricle reconstruction in microtia patients. MethodsBetween July 2010 and April 2015, 23 patients with low hairline microtia (23 ears) underwent low hairline auricle reconstruction. There were 16 males and 7 females with the mean age of 12 years (range, 6-34 years). The left ear was involved in 10 cases, and the right ear in 13 cases. There were 18 cases of lobule-type, 4 cases of concha-type, and 1 case of small conchatype. Referring to Nagata's two-stage auricular reconstruction method, the first stage operation included fabrication and grafting of autogenous costal cartilage framework; after 6 months, second stage operation of depilation and formation of cranioauricular sulcus was performed. The split-thickness scalp was taken from the part of the reconstructive ear above hairline. The hair follicles and subcutaneous tissue layers in hair area were cut off during operation. The area of depilation and auriculocephalic sulcus were covered with temporoparietal fascia flap. Then split-thickness skin was implanted on the surface of temporoparieta fascia flap. ResultsAll operations were successfully completed. Healing of incision by first intention was obtained, without related complication. The patients were followed up 6-20 months (mean, 12 months). The reconstructed ear had satisfactory appearance and had no hair growth. ConclusionThe application of splitthickness scalp graft and temporoparietal fascia flap in low hairline auricle reconstruction in microtia patients can achieve satisfactory results.
ObjectiveTo evaluate the clinical experiences and treatment effectiveness of chronic venous insufficiency with venous ulcer in lower limb. MethodsSeventy-eight patients (88 limbs) suffering lower limb chronic venous insufficiency with venous ulcer from May 2004 to April 2011 in this hospital were analyzed retrospectively. All the patients had undergone high ligation for great saphenous vein plus endovenous laser treatment plus subfascial endoscopic perforator vein surgery (SEPS). ResultsPostoperative complications included 3 cases of subfascial haematoma; 2 cases of pneumohypoderma; 3 cases of numbness in anterior tibial and ankle areas. All the ulcers healed between 4 to 6 weeks. Follow up period was between 6 months to 5 years. There was only one recurrence due to residual varicose from ankle area. The mean operation time was 20 min (15－30 min) in SEPS, the average blood loss was 2 ml (1－5 ml), and the mean duration of postoperative hospitalization was 5 d (2－8 d). ConclusionsSEPS is a first treatment choice for CVI with venous ulcer. It has less invasiveness, lower chances for bleeding, shorter operation time, quicker recovery, and fewer complications.
Objective To explore the application value of infrared thermography in the design and harvesting of ultrathin anterolateral thigh perforator flaps. Methods Between June 2024 and December 2024, 9 cases of ultrathin anterolateral thigh perforator flaps were designed and harvested with the assistance of infrared thermography. There were 7 males and 2 females, aged 21-61 years (mean, 39.8 years). The body mass index ranged from 19.49 to 26.45 kg/m² (mean, 23.85 kg/m²). Causes of injury included 5 cases of traffic accident injuries and 4 cases of machine crush injuries. There were 3 cases of leg wounds, 2 cases of foot wounds, and 4 cases of hand wounds. After debridement, the size of wound ranged from 7 cm×4 cm to 13 cm×11 cm. The time from admission to flap repair surgery was 5-12 days (mean, 7 days). Preoperatively, perforator localization was performed using a traditional Doppler flow detector and infrared thermography, respectively. The results were compared with the actual intraoperative locations; a discrepancy ≤10 mm was considered as consistent localization (positive), and the positive predictive value was calculated. All 9 cases were repaired with ultrathin anterolateral thigh perforator flaps designed and harvested based on thermographic images. The size of flap ranged from 8 cm×5 cm to 14 cm×8 cm, with a thickness of 3-6 mm (mean, 5.2 mm). One donor site was repaired with a full-thickness skin graft, and the others were sutured directly. Postoperatively, anti-inflammatory, anticoagulant, and anti-vascular spasm treatments were administered, and follow-up was conducted. ResultsThe Doppler flow detector identified 22 perforating vessels within the set range, among which 16 were confirmed as superficial fascia layer perforators intraoperatively, with a positive predictive value of 72.7%. The infrared thermograph detected 23 superficial fascia layer perforating vessels, and 21 were verified intraoperatively, with a positive predictive value of 91.3%. There was no significant difference between the two methods [OR (95%CI)=3.93 (0.70, 22.15), P=0.100]. The perforator localization time of the infrared thermograph was (5.1±1.3) minutes, which was significantly shorter than that of the Doppler flow detector [(10.1±2.6) minutes; MD (95%CI)=–5.00 (–7.08, –2.91), P<0.001]. Postoperatively, 1 case of distal flap necrosis healed after dressing change; all other flaps survived successfully. The skin grafts at donor site survived, and all incisions healed by first intention. All patients were followed up 3-6 months (mean, 4.7 months). No pain or other discomfort occurred at the donor or recipient sites. All patients with foot wounds could walk with shoes, and no secondary flap revision was required. Flaps in 3 hand wound cases, 2 foot wound cases, and 3 leg wound cases recovered light touch and pressure sensation, but not pain or temperature sensation; the remaining 2 cases had no sensory recovery.ConclusionPreoperative localization using infrared thermography for repairing ultrathin anterolateral thigh perforator flaps can help evaluate the blood supply status of perforators, reduce complications, and improve surgical safety and flap survival rate.
Objective To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus. Methods Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures. Results All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal. ConclusionFascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.
Objective To investigate the efficacy on clinical condition assessment and the safety of ultrasound-guided osteofascial chamber puncture manometry in evaluating the pressure of the osteofascial chamber in patients with venomous snake bites. Methods Patients with venomous snake bites admitted to the Department of Emergency Medicine of West China Hospital of Sichuan University between April 2021 and January 2023 were prospectively included, and their basic information, physiological indicators (heart rate, blood pressure), laboratory examination indicators, physical signs, treatment methods and prognosis were collected. The patients whose extremal pressure was measured by osteofascial chamber puncture under ultrasound guidance were selected as the manometry group. Patients who were bitten by venomous snakes at the same time without puncture pressure measurement were randomly selected as the control group at a ratio of 1∶1. The bleeding, infection, nerve injury, length of hospital stay and long-term prognosis of the two groups were compared to explore the safety of ultrasound-guided osteofascial chamber puncture manometry. The correlation between the pressure measured in the manometry group and creatine kinase (a representative index of acute poisoning severity score) was analyzed to explore the efficacy of ultrasound-guided osteofascial chamber puncture manometry in evaluating the disease. Results There was no significant difference between the manometry group and the control group in new or aggravated infection, bleeding, nerve injury (such as numbness and anesthesia), hospital treatment time, final detumescence time of the affected limb, or final adverse prognosis (P>0.05). There was a positive correlation between the measured pressure and creatine kinase (rs=0.286, P=0.002). Conclusions The higher pressure measured by ultrasound-guided osteofascial chamber puncture manometry is, the more serious the poisoning condition may be. In addition, ultrasound-guided osteofascial chamber puncture manometry does not prolong the hospital time of patients or the final swelling reduction time of the affected limb, and does not increase the incidence of bleeding, infection, nerve damage or eventual adverse prognosis events. It has clinical practicability and feasibility.
Objective To investigate the surgical treatment method and the curative effect of tibial nonunion with superficial peroneal vascular fascia pedicel tibiofibular periosteal flap. Methods From January 1996 to December 2008, 18 cases of tibial nonunion were treated with superficial peroneal vascular fascia pedicel tibiofibular periosteal flap, interlockingintramedullary nail ing and cancellous bone graft of distal tibial. There were 14 males and 4 females, with an average age of 32.5 years old (range, 24-67 years old). Fracture site was middle in 10 cases and distal in 8 cases. Primary injury cause included 12 cases of traffic accident and 6 cases of bruise. The tibial nonunion reasons were manual reduction and plaster immobil ization in 8 cases, small spl int immobil ization in 4 cases, intramedullary nail fixation in 2 cases (no bone graft), plate fixation in 4 cases (including 3 cases of plate fixation and free il iac bone graft). Nonunion occurred after the first surgery. The time from nonunion to operation was 8 to 16 months, with an average of 10.5 months. The size of periosteal flap was 7 cm × 5 cm and distal tibial cancellous bone graft volume was 5-10 g. Results All incision achieved heal ing by first intention after operation without flap necrosis and infection. All patients were followed up 6-36 months with an average of 20.8 months. All tibial nonunion healed 5-7 months after operation. According to Johner-Wruh scoring, the results were excellent in 14 cases, good in 3 cases, and fair in 1 case; the excellent and good rate was 94.4%. Conclusion Superficial peroneal vascular tibiofibularfascia pedicel tibiofibular periosteal flap and interlocking intramedullary nail ing can attain good results in treating nonunion of tibia and fibula because of being stable internal fixation and promoting the heal ing of nonunion.
Objective To explore the effect of deep muscle stimulation (DMS) combined with exercise therapy on morphological changes of the trapezius muscle assessed by musculoskeletal ultrasound and the function for patients with neck and shoulder myofascial pain syndrome (MPS). Methods One hundred and twenty patients with neck and shoulder MPS admitted to the First People’s Hospital of Shuangliu District, Chengdu between August 2021 and December 2022 were randomly selected and divided into 4 groups. There were 30 cases in each group. Group A received modulated middle frequency electrotherapy, group B received modulated middle frequency electrotherapy combined with DMS, group C received modulated middle frequency electrotherapy combined with exercise therapy, and group D received modulated middle frequency electrotherapy, DMS combined with exercise therapy. Before treatment and after 4 weeks of treatment, shear wave elastography was used to detect the shear wave velocity (SWV) of the four groups, high frequency ultrasound was used to detect the muscle thickness of the trapezius muscle. The Visual Analogue Scale (VAS) scores, Neck Disability Index (NDI), modified Barthel Index (MBI), Instrumental Activities of Daily Living Scale (IADL), World Health Organization Quality of Life-BREF (WHOQOL-BREF), Self-rating Anxiety Scale (SAS), and Self-rating Anxiety Scale (SDS) were also assessed to compare the therapeutic effects among the four groups of patients under different intervention methods. Results Before treatment, there was no significant difference in trapezius muscle SWV, trapezius muscle thickness, VAS, NDI, MBI, IADL, WHOQOL-BREF, SAS or SDS among the four groups (P>0.05). After 4 weeks of treatment, there were significant differences in trapezius muscle SWV, VAS, NDI, WHOQOL-BREF in the physiological domain and psychological domain, SAS and SDS among the four groups (P<0.05), and the improvements of trapezius muscle SWV, WHOQOL-BREF in the physiological domain and psychological domain, and SDS in group D were more obvious than those in other groups (P<0.05). After 4 weeks of treatment, there was no significant difference in MBI, IADL, or WHOQOL-BREF in the society domain and environmental domain among the four groups (P>0.05). Conclusion DMS combined with exercise therapy can significantly improve trapezius muscle elasticity, psychological state and quality of life of patients with neck and shoulder MPS.