Objective To evaluate therapeutic effect of endovascular treatment of iliac,femoral or popliteal artery injury with VIABAHN stent.Methods Endovascular treatment of iliac,femoral or popliteal artery injury was performed with VIABAHN stents in 12 patients admitted to our hospital from August 2015 to December 2013.Results Technical success rate was 100％.Strong instant postoperative pulsation of all dorsal and posterior tibial arteries could be palpated.No procedural and postoperative short term complications (endoleak,stent migration,hematoma at puncture site,thrombosis in arteries and stents and contrast nephropathy) were found.ABI value of injured lower limbs was promoted from preoperative 0.45 ± 0.12 to postoperative 0.95 ± 0.06.Mild stenosis (＜ 30％) of proximal end of stent was noted in one case by CTA.Patients were followed up for 3-18 months [averaging (10 ± 4) months].There was no postoperative limb ischeamia related symptoms.ABI was above 0.9 in all patients.Conclusion The short and middle term therapeutic effect of endovascular treatment of iliac,femoral and popliteal artery injury with VIABAHN stent was satisfactory.

OBJECTIVETo explore the biological characteristics of fibroblasts in adult granulation tissue in vitro, including cell viability, CD phenotypic, factor and protein expression, and differentiation, so as to facilitate further research of the role of fibroblasts in early wound healing.

METHODSFibroblasts were isolated from human granulation tissue and cultured by mechanical and enzymatic digestion method. The cell morphology and proliferation were observed under inverted phase contrast microscope. The first and third passages of cells' growth curve were drawn respectively. The surface markers (CD105, CD73, CD90, CD44, CD34, CD45, CD19, CD11b, HLA-DR) of the first and third passage fibroblasts were identified by Flow Cytometry. And the expression of Vimentin, CK19, CD31 and Factor VIII were detected by immunocytochemistry.

RESULTSPrimary cultured fibroblasts were short spindle, polygonal and irregular in shape. The morphology of fibroblasts were uniform by repeatedly passage cultured in vitro and showed spindle-shaped. The proliferative capacity of the fibroblasts were not significantly different, with logarithmic growth phase. From 1 to 4 days, The primary and third passage cells' proliferation was no difference (P > 0.05), After the five days, the proliferative ability of third generation was better than the primary passage (P < 0.01). All fibroblasts highly expressed mesenchymal stem cells' surface markers CD105, CD73, CD90 and CD44, and didnt express hematopoietic stem cells' surface markers CD34, CD45, CD19, CD11b and HLA-DR. The expression of mesenchymal stem cells' surface markers in third generation of cells were increased significantly. Immunocytochemistry showed positive expression of Vimentin, CD31, and negative expression of CK19 and Factor VIII.

CONCLUSIONSFibroblasts in human granulation tissue show the biology characteristics of Mesenchymal Stem Cells. Some biological markers of endothelial cells are expressed in fibroblasts in granulation tissue. The fibroblasts may play an important role during the process of endothelial to mesenchymal transformation in early wound healing.

Cell Differentiation ; Cell Proliferation ; Cells, Cultured ; Fibroblasts ; cytology ; Gene Expression ; Humans

BACKGROUND: Medialis pedis flaps have been widely used in the clinical practice due to their good color and luster,texture as well as the restoration of protective sensation. But little is known about the precise anatomic data of innervation of medialis pedis flaps.OBJECTIVE: Based on identification of local anatomic relationship, this study was designed to repair tissue defects adjacent to Achilles tendon using medialis pedis flaps with saphenous nerve and observe the repairing effects.DESIGN: A single-sample study.SETTING: Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College & Department of Anatomy, Zunyi Medical and Pharmaceutical College.PARTICIPANTS: Eleven patients with defects at Achilles tendon and/or local skin, who received treatment in the Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College between January 2004 and June 2007, were recruited into the present study. These patients, composed of 7 males and 4 females, were aged 15-40 years.METHODS: This experiment was performed at the Department of Anatomy, Zunyi Medical and Pharmaceutical College between January 2004 and June 2007. Twenty specimens of lower limb were from 12 cadavers obtained in the Department of Anatomy, Zunyi Medical and Pharmaceutical College and from 8 amputated extremities in the Department of Plastic Surgery,Affiliated Hospital of Zunyi Medical College (Informed consents for the application of amputated extremities have been acquired from the patients). The 20 specimens of adult lower limb were perfused with red emulsion to anatomically study the origin, course, number, size and distribution of the medial plantar artery and the number and distribution of the saphenous nerve in the medial malleolus. Concurrently, repair of tissue defects adjacent to Achilles tendon using medialis pedis flaps with saphenous nerve was performed in 11 patients in the Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College. Pedicle skin flaps were used in the 11 patients by transplantation.The Hospital's Ethics Committee approved the following protocol. After surgery, 1 24-month follow-up observation was performed by further consultation to study the color and luster, and the texture of the flaps, as well as the two-point discrimination difference compared with the opposite medial plantar area.MAIN OUTCOME MEASURES: Vascular nerves, which dominate medialis pedis flaps with saphenous nerve, as well as the appearance and function of these flaps after repairing tissue defects adjacent to Achilles tendon.RESULTS: Anatomic observation results: 1.0- 2.0 cm after its origin, the medial plantar artery divided into a superficial and a deep branch. The superficial branch of the medial plantar artery passed through the abductor muscle of great toe and originated around the tuberosity of navicular bone with an outer diameter of (1.0± 0.2) mm (adult). The deep branch was the direct continuation of the medial plantar artery, with an outer diameter of (1.5±0.3) mm (adult). 2.5-5.0 cm away from the medial plantar artery, the deep branch divided into a medial deep and a lateral deep branch. The medial deep branch passed through the abductor muscle of great toe deeply and sub-divided into the medial branch (cutaneous branch) and the lateral branch at the branching point of the medial and lateral deep branches. Clinical application: Altogether 11 flaps were used in the present study. All flaps were successfully transplanted without early vascular risk or flap necrosis. Among 7 patients followed up, 2 were followed up for I month, 3 for 6 months, 1 for I year, and I for 2 years. Follow up results showed that the transplanted flaps had good color and luster, texture, and appearance. There was no difference in two-point discrimination between the flap and the opposite medial plantar area.CONCLUSION: Medialis pedis flaps is blood-supplied by the superficial branch of the medial plantar artery that is an absolutely dominated area of the saphenous nerve. Medialis pedis flaps with saphenous nerve can repair Achilles tendon and adjacent tissue defects, possessing the advantages of less anatomic variation, easy resection, and good repair effects.

Objective To explore an anatomical basis for the lateral tarsal artery pedicle flap on front and lateral compartment of leg and the feasibility of repairing skin defects on forepart of feet. Methods The branches, course and anastomosis of the lateral tarsal artery, perforator of peroneal artery up external malleolus, superficial peroneal artery were studied in 20 legs of adult cadavers.The flap was designed on these grounds. 8 cases repaired by lateral tarsal artery pedicle flap on front and lateral compartment of leg, 5 cases of skin defects on dorsum of foots, 3 cases of skin defects on footplates.The area of defect on forepart of foot was 5 cm× 4 cm-cm × 5 cm. The donor sites were resurfaced with skin grafts or sutured directly. The lateral tarsal artery, perforator of peroneal artery up external malleolus, perforator of anterior tibial artery superficial peroneal artery were anastomosed each other, formed single band blood vessel axle on lateral foot, fore external malleolus, front and lateral compartment of leg. The area of flap was 6 cm × 4 cm - 10 cm × 6 cm.Results All of the flaps survived completely. All cases were followed up, followed up 6- 12 months, averaged 8 months. The color, appearance and texture of the flaps were good, without ulcer on the flap. The patients can walk freely. Conclusion The flap on front and lateral compartment of leg should be designed according to the lateral tarsal artery. Blood supply of flap was reliable, little trauma. The flap's vessel pedicle is enough long. It could repair any defect on forepart of foots.

he donor sites of the intermediate dorsal neurocutaneous flap on the foot. Conclusion The donor sites of the dorsal artery flaps can be repaired by the intermediate dorsal neurocutaneous flaps on the foot.The method is simple, applicable, safety.

Objective To investigate the method of repairing great wounds on foots and ankles with posterior tibial artery perforator-based dicyto-pattern flaps from interior and posterior compartment of leg. Methods Eighteen patients with great foot wound were repaired with posterior tibial artery perforator-based dicyto-pattern flaps from interoposterior compartment of calf from January 2006 to December 2008. The patients were at age of 16-52 years, with flap areas for 20 cm ×6 cm-25 cm × 10 cm. The donor sites of flaps were repaired with free skin graft. Results All the flaps primarily survived except for one patient with partial necrosis (4.0 cm × 1.0 cm) in the distal part of the flap. Twelve patients were followed up for from two months to two years, which showed good color, texture and appearance of the flaps. Conclusion This kind of flap is one of ideal flaps to repair great foot and ankle wounds, for it takes advantages of reliable blood supply, wide repair scope, safe operation and avoidance of damage to the major artery.

OBJECTIVETo explore the clinical effects of relaying reversed perforator flaps in repairing skin and soft tissue defects at distal end of finger and donor site.

METHODSSeventeen patients (17 fingers) with skin and soft tissue defects at distal end of finger were hospitalized from June 2011 to June 2013. The reversed digital artery perforator flap with branch of digital nerve was used to repair the defect. The first donor site was repaired by dorsal metacarpal artery perforator flap; the second donor site was closed by suturing. The area of skin defect at distal end of finger ranged from 2.0 cm x 1.5 cm to 3.0 cm x 2.0 cm, and the area of digital artery perforator flap and dorsal metacarpal artery perforator flap ranged from 2.2 cm x 1.5 cm to 3.6 cm x 2.5 cm and 2.5 cm x 2.0 cm to 4.2 cm x 3.0 cm, respectively.

RESULTSAll the 34 flaps survived completely. Cyanosis and partial necrosis of the epidermis appeared in 1 flap, which was healed after dressing change. All the patients were followed up for 1 to 18 months, with mean time of 8 months. The color, texture and appearance of flaps were satisfactory. There was no depression or breakdown in the first donor sites. Some linear scars appeared in the second donor sites, but they did not affect the general appearance. The donor sites at joint or tendon did not affect the joint activity after healing. The results of function evaluation of range of active movement of the fingers were excellent in 15 cases and good in 2 cases. The results of sensation of the flaps were S3 in 1 finger, S4 in 2 fingers, and S5 in 14 fingers. The distance of two-point discrimination of flaps ranged from 5 to 7 mm, with mean distance of 6 mm.

CONCLUSIONSRelaying reversed perforator flap, with reliable blood supply and both donor sites in the hand, can improve the appearance and function of the first donor site as well as repair skin and soft tissue defects at distal end of finger.

Cicatrix ; Depression ; Epidermis ; Extremities ; Finger Injuries ; surgery ; Humans ; Perforator Flap ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Sutures ; Tendons ; Treatment Outcome ; Wound Healing

Objective To investigate the clinical effect of inherent artery dorsal perforator flaps of thumb radial palmar for coverage of ipsilateral thumb degree Ⅰ and Ⅱ oblique defect of the fingertip.Methods The study included 6 males and 6 females,aged 10-40 years (mean 30 years),with thumb fingertip Ⅰ and Ⅱ degree defect treated between October 2009 and October 2013.Injury resulted from machinery cutting injury in 4 patients,machinery twist injury in 3,cutting by sharp weapons in 3,and crush injury in 2.There were 6 patients with Ⅰ degree defect and 6 patients with Ⅱ degree defect.Defects were all oblique involving more in the radial side rather than in the ulnar side and reconstructed with thumb radial palmar artery perforator flaps.Flap ranged in size from 1 cm × 2 cm to 1.5 cm × 2.5 cm.Donor site was covered with skin grafts.Observation indexes were wound healing condition,flap color,flap swelling degree,and flap temperature.Finger function was measured with upper extremity scoring system formulated by Hand Surgery Branch of Chinese Medical Association.Results All flaps survived and achieved good protective sensation.Wound healed primarily.Color,temperature and texture of the flap returned to almost normal.Moderate swelling of the flaps was detected and subsided around one week.All patients were followed up for 1-36 months (mean 20 months).At the final follow-up,two-point discrimination was 9-11 mm (mean 10 mm).Two patients developed distal interphalangeal joint stiffness and recovered after rehabilitation exercise.Finger function was rated as excellent in 10 cases and good in 2.Conclusion Inherent artery dorsal perforator flap of thumb radial palmar has affirmative effect and allows maximum preservation of finger length and function when applied to repair ipsilateral thumb degree Ⅰ and Ⅱ oblique defect of the fingertip.

Objective To summarize the clinical efficacy of free KISS lateral femoral circumflex artery perforator flap in repairing defects of limbs.Methods Twelve cases were suffered wound surface defects on hands and feet.And the defects were repaired by flap construction from October,2010 to May,2013,based on the characteristics of the defects combined with anatomical features of the free lateral femoral circumflex artery perforator flap.Length of flap was adopted as the width for direct suture in the flap donor.Results Postoperative flap and donor area preliminarily healed.There was no vascular crisis.Twelve cases received 6-18 months followed-up (averaged of 12 months).The skin flap was good in color and texture.The dorsal flap was a bit bloated.Linear scar was remained in distal flap donor area.The quadriceps muscle power level 5,knee flexion,extension 10°-180°.Quadriceps strength,knee flexion and stretch activities were all normal.The flaps recovered protective sense.Four cases had tendon adhesion after hand tendon transplantation.The finger function was well recovered after release.At the last followup,the functions of the upper limbs were evaluated according to the trial evaluation standard of the Hand Surgery Association of Chinese Medical Association:6 cases were excellent,1 case was good,and 1 case was qualified.Conclusion The design of the lobulated tissue flap of the lateral femoral circumflex artery descending branch is flexible.Large area of the surface defect can be repaired.The flap donor area is directly sutured.It is an ideal method to repair the wound tissue defect.

Objective To investigate the feasibility of advanced sensate proper digital artery escalating flaps in reconstruction of fingertip skin defect.Methods Between January 2012 and February 2015,15 cases (17 fingers) of fingertip skin defect accompanied with exposed tendon or phalange were treated,including 9 males and 6 females,with mean 41 years of age (range,7-55 years).Injury resulted from hit by heavy objects in 5 cases,knife cutting in 4,machine twist injury in 4 and mass resection in 2.Fingertip defects were covered with the flaps carrying proper digital artery and nerves in order to one-stage reconstruct finger pulp epicritic sensibility and avoid onychogryphosis.Joint function was assessed with the standard set up by Chinese Medical Association Hand Surgery Branch.Results All flaps survived.One case had ankylosis of the middle interphalangeal joint caused by poor weight-bearing exercise and was improved after exercise.Two cases with large defect in the distal finger pulp had slight onychogryphosis after operation.Period of follow-up was 6-14 months (mean,8 months).The injured fingers showed good appearance and sense,with two-point discrimination of the flap ranging from 6-8 mm.There was no linear scar or tenderness in the finger tip.Hypertrophic scar was not obvious in the flap donor area.Function assessment was excellent in 16 fingers and good in 1 finger.Conclusion The flaps result in good blood supply,good sense,no onychogryphosis and no linear scar and are easy to be operated,indicating an ideal method to reconstruct fingertip defect.