ObjectiveTo explore the advantages and disadvantages of preoperative biliary drainage, the timing of preoperative biliary drainage, and the characteristics of various drainage methods for resectable hilar cholangiocarcinoma.MethodsBy reviewing relevant literatures at home and abroad in the past 20 years, the controversies related to the preoperative biliary drainage, surgical biliary drainage, and various drainage methods for resectable hilar cholangiocarcinoma were reviewed.ResultsThere is still a great deal of controversy about whether preoperative bile duct drainage is required for resectable hilar cholangiocarcinoma routinely, but there is a consensus on the timing of preoperative biliary drainage, and various drainage methods have their own characteristics.ConclusionsThe main treatment for hilar cholangiocarcinoma is radical surgical resection, but cholestasis is often caused by malignant biliary obstruction, which makes it difficult to manage perioperatively. A large number of prospective studies are needed to provide more evidence for the need for routine preoperative biliary drainage in patients with hilar cholangiocarcinoma who can undergo resection.
ObjectiveTo investigate the feasibil ity and effectiveness of using scar spl it thickness skin grafts combined with acellular allogeneic dermis in the treatment of large deep Ⅱ degree burn scar. MethodsBetween January 2013 and December 2013, 20 cases of large deep Ⅱ degree burn scar undergoing plastic operation were enrolled. There were 14 males and 6 females, aged 4 to 60 years (mean, 40 years). Burn reasons included hydrothermal burns in 10 cases, flame burns in 9 cases, and lime burns in 1 case. The burn area accounted for 70% to 96% total body surface area (TBSA) with an average of 79% TBSA. The time from wound healing to scar repair was 3 months to 2 years (mean, 7 months). Based on self-control, 0.7 mm scar spl it thickness skin graft was used to repair the wound at the right side of joints after scar resection (control group, n=35), 0.5 mm scar spl it thickness skin graft combined with acellular allogeneic dermis at the left side of joints (trial group, n=30). Difference was not statistically significant in the scar sites between 2 groups (Z=-1.152, P=0.249). After grafting, negative pressure drainage was given for 10 days; plaster was used for immobilization till wound heal ing; and all patients underwent regular rehabil itation exercises. ResultsNo significant difference was found in wound heal ing, infection, and healing time between 2 groups (P>0.05). All patients were followed up for 6 months. According to the Vancouver Scar Scale (VSS), the score was 5.23±1.41 in trial group and was 10.17±2.26 in control group, showing significant difference (t=8.925, P=0.000). Referring to Activities of Daily Living (ADL) grading standards to assess joint function, the results were excellent in 8 cases, good in 20 cases, fair in 1 case, and poor in 1 case in trial group; the results were excellent in 3 cases, good in 5 cases, fair in 22 cases, and poor in 5 cases in control group; and difference was statistically significant (Z=-4.894, P=0.000). ConclusionA combination of scar spl it thickness skin graft and acellular allogeneic dermis in the treatment of large deep Ⅱ degree burn scar is feasible and can become one of solution to the problem of skin source tension.
From jan.1984 through dec.1991,65 cases of hand skin defects were primarily repaired by podicled groin flap. Four of the 65 cases had skin defects on both sides of the palms and dorsal aspot of the hands which were treated by the Y-shaped hypogastric groin flap .Five easec had thumb loss in which the lxdicled groin tubed flap was used to reconstruct the thumb.The time of division of the pedicles ranged from 14 to 28 days(averaged 16 days).All flape survived after division of the podicl...
In order to correct the dysfunction of head and neck with scar contracture, since 1980, sixty-two cases were undertaken the operation by using local skin flap to repair the soft tissue defect after scar resection. The skin flaps included pedicled delto-thoracic skin flap in 26 cases, cervico-thoracic skin flaps in 25 cases, cervico-shoulder flaps in 6 cases, pedicled vascularized extralong delto-thoracic skin flap in 4 cases and free parascapular flap in 1 case. Sixty cases had total survival of the flaps and 2 flaps had partial necrosis. After 1 to 10 years follow-up, the appearance and function of neck were excellent. It was suggested that grafting local skin flap was a good method to treat cicatricial deformity of neck especially using the skin flap with pedicle and vascular bundle.
ObjectiveTo study the effects of the new small molecular oxygen free radical scavenger Tempol on the survival and vasculogenesis of the long random pattern skin flap (LRPSF) and its mechanism. MethodsEighty-four male Sprague Dawley rats were randomly divided into control and Tempol groups (42 rats in each group). LRPSF of 9 cm×3 cm in size were prepared on the backs of rats in two groups based on the Mcfarlane flap. Rats were administered with Tempol (100 mg/kg) in the Tempol group and with normal saline in the control group by intraperitoneal injection at 15 minutes before operation and at 1-7 day after operation. The rat and the skin flap survival conditions were observed after operation; the survival rate of skin flap was measured, and the vascular structure, vascular volume, and total length of blood vessels were analyzed with Micro-CT three-dimensional imaging after 7 days; HE staining was used to observe the structure of the skin flaps and inflammation, immumohistochemical staining to observe vascular endothelial growth factor (VEGF) expression; water-soluble tetrazolium-1 method was used to measure the content of superoxide dismutase (SOD) and malondialdehyde (MDA), and ELISA to detect the expressions of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) after 1, 3, and 7 days. ResultsAll of rats survived after operation, without hemorrhage, edema, and infection. With the extension of time, necrosis occurred in the distal part of the skin flaps in 2 groups, but the necrosis degree of the Tempol group was lower than that of control group; meanwhile, the blood vessel distribution and continuity were better than those of control group. The skin flaps survival rate, vascular volume, and total length of blood vessels of Tempol group were significantly higher than those of control group after 7 days (P<0.05). The clearer skin flaps structure, lighter inflammation reaction and inflammation cell infiltration, and higher VEGF staining intensity were observed in the Tempol group than the control group after 7 days. There was no significant difference in SOD, MDA, and TNF-α, and IL-6 contents between the 2 groups at immediate after operation. SOD significantly increased, but MDA, TNF-α, and IL-6 contents significantly decreased in the Tempol group when compared with control group after 1, 3, and 7 days (P<0.05). ConclusionTempol can significantly promote the LRPSF survival rates, its mechanism is closely related to the promotion of vasculogenesis and reduction of oxidative stress and inflammation.
OBJECTIVE To investigate the clinical result in repair of soft tissue defect with combined skin flap vascularized by pedicle on the one end and vascular anastomosis on the other end. METHODS From October 1990 to August 1995, 5 cases with soft tissue defect at the extremities and 1 cases with sacral bed sore were repaired by the combined skin flaps transfer, ranged from 15 cm x 30 cm to 16 cm x 70 cm in defect, among them, 5 cases with myocutaneous flap and 1 case with skin flap, and the size of the combined skin flaps was 15 cm x 40 cm to 12 cm x 80 cm. RESULTS All the flaps were survived with satisfactory effect. Followed up 3 to 6 years, there was no obvious complication. CONCLUSION Transfer of combined skin flaps vascularized by pedicle and vascular anastomosis is suitable to repair the soft tissue defect, especially in large area defect.
Objective To search the most suitable concentration of calcium in the medium for the basement membrane reconstruction in tissue engineering skin in vitro. Methods Composite chitosan tissue engineering skin was prepared according to previous studies. Four groups were included according to the concentrationof calcium (1.00, 1.45, 1.65 and 1.95 mmol/L respectively). After 7 days and 15 days of culture, the histological manifestation of basement membrane in tissue engineering skin was observed by hematoxylin amp; eosin staining and PAS staining, and collagen Ⅳ of basement membrane was detected immunohistochemicallyatthe dermalepidermal junction. Results This tissue engineering skin shared some histological features of normal skin, including a welldifferentiated stratifiedepidermis and a dense dermis. The epithelium in the group of 1.95 mmol/L calcium differentiated better than those in other groups. PAS staining showing a regularly red dying strap domain at the dermal-epidermal junction. Collagen Ⅳ was positively stained immunohistochemically at the dermalepidermal junction inthe tissue engineering skin. Conclusion The above results suggest that the medium with 1.95 mmol/L calcium should be suitable for the growth of composite chitosan tissue engineering skin and the reconstruction of basement membrane.
In order to investigate the mechanism of blood supply to the delayed separated skin flap and the time and criteria for its transfer, 5 smallsized Banna pigs were selected to produce 14 skin flaps. In the experimental group the skin flap on one side was made from the middle of the back having an extrathin steel sheet intervened between the flap and the soft tissue of the back whereas the flap on the opposite side without a steel sheet intervened was served as the selfcontrol. The skin flaps were examined 3,7,10 and 20 days after the operation and 3,7 and 10 days after transfer, respectively, by (1) gross observation; (2) ultrasonic Doppler; (3) superficial skin temperature measurement and; (4) histomorphological examination. In the experimentalgroup the survival rate of the flap was 100 percent whereas in the control group all of the flaps had necrosis from 30 to 50 percent after the flap being transfered. In the experimental group, the echo sound from the arterial blood flow from ultrasonic Doppler was heard at the pedicle 7 days after the operation, and as time elapsed, the echo sound spread distally, whereas in the controls no echo sound could be heard over the skin flap. There was significant difference statistically between the experimental and control groups in the temperature of the flaps while the flaps were being transferred (P lt; 0.01). The external diameters of the blood vessels in the central area of the skin flap were larger in the experimental group, 0.8 to l.2mm in comparison to 0.4mm.
The clinical experiences in the appieation of umbilical-thoracic skin flap in the coverage of the defect of the forearm in 9 cases were reported. The flap was supplied by the branches of inferior epigastric artery.The biggest flap was 8.5×28cm,the smallest one was 7× 16cm.All flaps surviVed.The results were satisfactory. The advantages of the flap were:(1)potients felt comfortable when the upper extremity was immobilized at the side of the they;(2)the size of skin taken from the do...
Objective To build artificial dermis by using the acellular dermis matrix(ADM), collagen membrane and collagen gel as scaffolds. Methods The fibroblasts were isolated by enzyme from infant skin and were cultivated in the DMEM medium. After 14 days when the fibroblasts were seeded into 3 different scaffolds, the autografts were detected by HE staining, transmission electron microscope and scanning electron microscope. Results ①The fibroblasts obtained from the fullskin by enzyme could be passaged in the Dulbecco’s modified Eagle’s medium 2high gluco se w ith 10% calf bovine serum. ②A layer of fibroblastsw ere found on the surface of th ree different scaffo lds, the fibroblasts could grow into the co llagen membrane and the co llagengel, but could no t be found in the inner of ADM. ③A rt ificial derm is cont racted slightly by inoculat ing fabricat ion on collagen membrane and ADM , and the fibroblasts on them w ere no t act ive in proliferat ing; but the art ificial derm is built by the collagen gel cont racted obviously. Conclus ion The art ificial dermis built by ADM , collagen membrane and collagen gel as scaffolds have a preferable structure for an ideal subst itute of sk n, and can beused as the graft in the next experiments.