The present preliminary study was to observe the feasibility of the use of polylactic acid gel (PLA-G) in modified radical mastectomy and the ability of the PLA-G in the prevention of flap adhesion after operation. Sixty-eight patients were diagnosed with breast cancer, and received modified radical mastectomy from Jan. 2004 to Dec. 2006. The patients were divided randomly into a treatment group and a control group (with 34 cases each). The PLA-G was used under the surface of the auxiliary operative wound in the treatment group, and nothing was used in the control group. The wound healing, the wound complication, the amount of drainage solution, the indwelling time of the drainage tube and the auxiliary skin adhesion were evaluated after operation in both groups. There were no statistical difference on wound healing between the first intension (29:27) and the second intention (5:7), and the wound dehiscence after taking the stitches out (0:0) between the two intensions, the hematoma (0:1) and the effusion of the wound (5:6), and the flap necrosis (1:2) between two groups. There were also no statistical difference on the amount of drainage solution per day (6 +/- 3) and indwelling time of the drainage tube (6 +/- 4) after operation between the two groups (P > 0.5). After the operation, the case load with no flap adhesion in the treatment group was significant higher compared with the control group (22:8). The case load with complete acquired skin flap adhesion in the treatment group was visibly lower than in the control group (3:19), which proved that there was a significant statistical difference between the two groups (P < 0.05). This study suggested that the using of PLA-G in the breast cancer modified radical mastectomy could prevent skin flap adhesion without any harmful effects in the wound healing.
Breast Neoplasms ; surgery ; Drainage ; Female ; Gels ; therapeutic use ; Humans ; Lactic Acid ; therapeutic use ; Mastectomy, Modified Radical ; Necrosis ; Polyesters ; Polymers ; therapeutic use ; Surgical Flaps ; Tissue Adhesions ; prevention & control ; Wound Healing

Objective:To study the soft tissue inflammation of percutaneous implants using bacteria investigation method, so as to provide basic data for further clinical study of percutaneous implants. Methods: Implants were surgically placed into tibias of the goats. The inflammatory secretion from the peri-implant soft tissue was taken to perform bacteria test on 4, 6 and 9 weeks post-operation. Meanwhile, the soft tissue inflammatory reaction was also observed weekly. Results: 5 of the 16 implants were infected. The soft tissue showed tumefaction and ulceration 2 months post-surgery. As to bacteria investigation, the number of G.Streptococci increased when the inflammation was getting more severe. Conclusion: The extent of the soft tissue inflammation of percutaneous implants probably has positive correlation with the infection of G.Streptococci.

Objective To evaluate the clinical outcomes of a hovel porous β-tricalcium phosphate (β-TCP)and control allograft for the repair of lacunar bone defects caused by solitary bone cyst curettage.Methods From January 2003 to December 2008,the patients with solitary bone cyst were randomized into an experimental(55 cases)and a control(40 cases)group.The control group received particulate allograft bone as the graft material,and the experimental group received β-TCP.At 1 week,1,2,3,6,12,24,48months after surgery,a new radiographic scoring system was employed to calculate the biodegradation of bone graft and evaluate the influence of multiple factors.Histologic characteristic of the degradation process of β-TCP were also evaluated.Results All the cases were followed up for average 28.4 months.Radiographic semi-quantitative analysis revealed that the biodegradation effieiencies were not significantly difierent between β-TCP and allografts(P=0.424).Degradation percentage of the implanted β-TCP or allograft was higher in younger patients than those in the older ones.Degradation of β-TCP was significantly higher than that of allografts over 3 years after surgery(P=0.04).In the experimental group,β-TCP degradation was greater in the loose packing treatment than that in the dense packing treatment (P=0.03).Histological observation demonstrated that the process of new bone formation accompanied the degradation of β-TCP.Conclusion The interporous β-TCP could be an advantageous alternative to allografts for repair bone defects caused by bone cyst.The clinical application of β-TCP is safe and reliable,which shows better biodegradation and osteogenesis than allografts in long-term follow-up.

ObjectiveAim at the problems in the treatments of the children malignant bone tumor of distal femur,we put forward the concept of the dual mobility hemi-knee prosthesis and try to perform the motion parameters analysis and the pilot clinical trials.MethodsBase on the CT data from samples of knee joint in adult,we adopted the Mimics/Geomagic/Pro-E software and computer numerical control milling machine technology to design and produce the dual mobility hemi-knee artificial prosthesis,and then motion parameters was analyzed in vitro test,and at last pilot clinical trial was performed.ResultsIn vitro experiment showed that the displacement of the internal femoral condyle flexion facet center was(2.59±0.43) mm in normal knee group,(2.22±0.52) mm in dual mobility hemi-knee prosthesis group,and (1.18±0.43) mm in total knee arthroplasty group; the displacement of the external femoral condyle flexion facet center was (11.95±6.62) mm in normal group,(11.25±6.19) mm in dual mobility hemi-knee prosthesis group,and (1.26±0.42) mm in total knee arthroplasty group; the maximum relative rotation angle was 13.17°±7.58° in normal knee group,11.69°±6.49° in dual mobility hemi-knee prosthesis group,and 5.40°±1.29° in total knee arthroplasty group.After that,we accomplished the pilot clinical trials successfully for a patient with malignant bone tumor in distal femur.The patient recovered well and the treatment outcome was satisfactory.ConclusionThe motion parameters analysis showed that the motion mode of the dual mobility hemi-knee prosthesis is similar with that of the normal knee.The dual mobility hemi-knee prosthesis provides a whole new concept and method for the treatment of malignant bone tumor of distal femur in children,and the device and concept of ligament reattachment provide a solution to the reconstruction of knee ligament.

Objective To analyze the image and histological results of the combined use of allograft/extracorporeally frozen tumor-bearing bone and vascularized fibular flap for the reconstruction of bony defects following tumor resection,guiding clinical practice.Methods From March 2007 to June 2013,we enrolled 63 patients who had combinative biological reconstruction after bone tumor resection (11 in humerus,22 in femur,21 in tibia,4 in calcaneus).There were 36 male and 27 female in this series.The average age at time of operation was 20 years,ranging from 9 to 48 years.The follow-up ranged from 16 to 102 months with average of 48 months.We investigated the X-ray and CT images for all patients and histological findings of two patients.Patients were assessed functionally with the Musculoskeletal Tumor Society 93 score.Results Three patients with local soft tissue recurrence and one patient with infection underwent amputation.The survival of construct was 93.6％.Bone union achieved in all cases with the average MSTS score of 92.8％.Bone union ranged from 11 to 28 months in allograft group and 9 to 14 months in devitalized tumor bearing bone group.Significant difference of bone union time was found between two groups (Z=-3.638,P=0.000).Viability of the fibular grafts was verified in 58 of 63 patients (92％).Three types of images were observed in complex.Osteopenia and spongy change in fibula were found in 51 patients (81％) with stable fixation of the complex.Five complexes with failed blood supply of fibula and stable fixation revealed no density change of fibula,small amount of callous formation and relative delayed union.In seven complexes (11％) with unstable complex due to patients' incompliance,fibula reacted with dense hypertrophy and microfracture.Fusion of grafts with amount of callus was obviously observed.Union at allograft-host bone junctions occurred by residual host bone-derived external callus and fibular-derived internal callus that bridged the junction and filled the gap between abutting cortices.Callus from fibular graft was mature than that from periosteum of residual host bone.Internal repair was observed at the internal surface of the allografts.Fibula showed significant spongy changes.Conclusion Recycled tumor-bearing bone in combined with fibular flap is a reliable reconstruction as an alternative to traditional Capanna technique.The survival of the fibula is a cornerstone in success of complex reconstruction.Sponginess of fibula and internal repair of allograft compromise the intensity of complex,necessitating the strong instrumentation during reconstruction.

BACKGROUND: RT-Q medical biomembrane, the novel copolymer synthesized from lactic acid and hyaluronic acid, not only possesses the advantages of hyaluronic acid, such as multiple biological functions, excellent flexibility and biocompatibility, but also has the merits of polylactic acid fragments to be easily processed and transformed to membrane when encountering water. OBJECTIVE: To investigate the hemostatic effect of RT-Q medical biomembrane in rat external jugular vein hemorrhage model, and to evaluate its histocompatibility by locally applying it to rat muscle. DESIGN: Randomized controlled animal trial.SETTING: Department of Pharmacology, Department of Pharmacognosy, West China School of Pharmacy, Sichuan University.MATERIALS: 130 male Wistar rats aged 6 weeks, weighing 170-210 g, were selected. Eighty rats were used for evaluation of hemostatic effect, and the other fifty were used in biocompatibility experiment. Animal intervention met the animal ethical standard. RT-Q aerosol composed of DL-lactic acid and hyaluronic acid, α-cyanoacrylate, acetone (solvent), freon (propellant) and excipient aerosol composed of acetone and freon (propellant) (Batch number 20050311) were provided by Department of Pharmaceutics, West China School of Pharmacy, Sichuan University.α-cyanoacrylate medical adhesive(SUNCON medical adhesive) (Batch number 20050930) was produced by Beijing Suncon Medical Adhesive Science and Technology Development Co., Ltd. METHODS: Haemostatic effect: Eighty male rats were randomly divided into four groups, served as RT-Q, SUNCON (positive control), excipient group and non-treatment group (negative control), twenty in each group. After anesthesia was induced, external jugular vein of rats was exposed, and an approximately 0.6 cm incision was made to create hemorrhage. The bleeding areas were blotted by antiseptic gauze. After removing the gauze, the bleeding surfaces were immediately treated with RT-Q aerosol in the RT-Q group, excipient aerosol in the excipient group, 0.15 mL SUNCON medical adhesive in the SUNCON group, or no agent in non-treatment group, respectively. Then, injury surfaces were covered by gauze. In the non-treatment group, bleeding was left to naturally stop. Bleeding time and blood loss (gauze weight after hemostasia - that before hemostasia) were determined. Local histocompatibility: Rats were divided into A and B groups. Incision was made in rat post-leg muscle after anesthesia was induced. Left bleeding surfaces were treated with excipient aerosol, and right bleeding surfaces were treated with RT-Q aerosol in group A (n=30). The same incision as the group A was made, but no intervention was performed in the group B (n=20). Tissues were possessed and HE-stained for pathological observation under light microscope at days 1, 2, 3, 4, 5, 6, 7, 15, 23, 30 after the surgery. Effect of biomembrane on wound healing, degradation and toxicity to tissues surrounding injuries were observed. MAIN OUTCOME MEASURES: Bleeding time and blood loss in hemostatic experiment; wound healing, biodegradation and toxicity to tissues surrounding injuries in local histocompatibility experiment. RESULTS: 130 rats were involved in the result analysis. Histopathologic examination showed RT-Q membrane had no effect of promoting or delaying wound healing. Membrane formed by RT-Q aerosol began to degrade on the 15th day, absorbed completely during 3-4 weeks, and had no toxicity to surrounding tissues. Bleeding time and blood loss were reduced in the RT-Q group than in the non-treatment group and the excipient group (P < 0.01). There was no significant difference between the RT-Q group and the SUNCON group (P > 0.05).CONCLUSION: RT-Q medical biomembrane as α-cyanoacrylate medical adhesive has significant hemostatic effects on topical bleeding, and possesses good histocompatibility.

Objective To explore the diagnostic value of needle stereotaction marking by steel wire(NSMSW) under mammography for nonpalpable early stage breast carcinoma (BC). Methods 29 patients with nonpalpable breast lesions were performed NSMSW under mammography,and the lesions were removed for biopsy to make the diagnosis. Results Nine patients(31.0%) were definited as early stage BC and twenty(69.0%) benign disease.The pathologic results in freezing sections and in parafin sections were the same. Conclusions NSMSW under mammography can resolve the problem of accurate location of nonpalpable breast lesions during operation .It is a credible, useful and practical method for diagnosis of nonpalpable early stage BC.

Objective To explore the feasibility of tibial nerve motor branches transfer to the deep fibular nerve in an anatomical study.Methods Twenty-three sides lower limbs from 12 adult cadavers which preserved in Formalin were used for dissection of the tibial nerve and its all motor branches,and the proximal deep and superficial fibular nerve.Experimental measurement were performed for the parameters of each branch such as length,diameter,the location of original point relative to the level of the fibular head.The diameter of proximal part of the deep fibular nerve was measured simultaneously.Finally,the length from original point of each branch to the fibular neck was also measured during simulation of nerve transfer procedure.Results The average length of motor branches to the flexor digitorum longus muscle,to the flexor hallucis longus muscle and the superficial branches to the soleus muscle were (95.70 ± 13.40)mm,(96.90± 13.60)mm and (73.60 ± 12.00)mm respectively.Their average diameter were (0.63 ± 0.16)mm,(0.65 ±0.20)mm and ( 1.56 ± 0.26)mm respectively.The average diameter of proximal deep fibular nerve was (2.54± 0.26)mm.Based on length,branches to the flexor digitorum longus muscle and flexor hallucis longus muscle were adequate for direct nerve transfer to the deep fibular nerve in all specimens without interpositional grafr.And in 22 specimens (95.7 percent),the superficial branches to the soleus muscle were long enough to directly transfer.Other branches of the tibial nerve were not adequate for direct nerve transfer Conclusion This study confirmed the anatomical feasibility of using motor branches from tibial nerve for direct transfer to restore the deep fibular nerve.The superficial branches to soleus muscle were the best donor nerve if considering the branches,length,diameter and the difficulty of surgical procedures.

Objective To investigate the effects of combined use of an allograft and vascularized fibular flap for the reconstruction of bone defects after intercalary resection of long bone malignancy.Methods From April 2006 to October 2009,19 patients that had intercalary resection of long bone malignancy (5 in humerus,7 in femur,7 in tibia)underwent reconstruction with an allograft and vascularized fibula construct,including 11 males and 8 females with an average age of 18.5 years.The average length of the defect was 13.2±4.3 cm.Free vascularized fibula flaps were used in 16 patients and ipsilateral pedicle vaseularized fibula grafts in 3.Time to union was recorded through evaluation of plain radiographs.Bone scan was used to evaluate the viability of the vascularized fibula.Patients were examined oncologically and radiographically and were assessed functionally with MSTS-93.Results The mean follow-up time was 27.5 months.The average length of the fibula flap was 17.9±5.2 cm.Viability of the fibular grafts was verified in all cases.The average time for bone union at allograft-host junction was 11.3±2.8 months in femur,14.1±3.3 in tibia,6.8±1.4 in humerus,respectively.The MSTS-93 average score at final follow-up was 95.2% in upper extremity and 91.8% in lower extremity.The oncology result in patients with follow-up more than 2 years was continuous disease free in 11 patients.no evidence of disease after recurrence following resection in 1,alive with tumor in 1,and died of lung metastasis in 1.Conclasion Vascularized fibular flap in combination with massive allograft provide an option for reconstruction of large bony defects after long bone malignancy extirpation.The viability of the fibula is a cornerstone in success of reconstruction that prevents allograft nonunion and result in decreased time to bone healing,leading to earlier patient's recovery of function.

Objective To discuss the significance of the retrograde urethrography in diagnosis and treatment of urethraltrauma. Methods 78 cases with urethraltrauma treated by the retrograde urethrography were retrospectively analyzed. Results The location and extent of urethral injury was determined according to the place and speed of contrast medium overflow and the diffuse range. Among 78 cases ,29 cases were bulbar urethral trauma and other 49 cases were membranous urethral trauma.Conclusion Retrograde urethrography is simple, practical and easy to operate for determining the injured part of urethra and the extent of damage of urethraltrauma, and was instructional for the choice of operation method and incision.