OBJECTIVETo summarize clinical application of the distal island muscle flap of the gastrocnemius muscle for repairing the defects around knee and within the upper 2/3 of lower leg.

METHODS18 patients with defects around knee and within the upper 2/3 of lower leg, were treated with the distal island muscle flap of the gastrocnemius muscle, including 12 cases with medial muscle head and 6 cases with lateral muscle head. The muscular flaps were covered with meshed split-thickness skin grafts. The wound at donor sites were closed directly.

RESULTSAll the skin grafts and muscle flaps survived with superior infection at the wound edge in two cases. The patients were followed up for 8 months to 4.8 years with satisfactory cosmetic and functional results.

CONCLUSIONSThe distal island muscle flap of the gastrocnemius muscle has a reliable blood supply, long pedicle and suitable thickness. It is an ideal method for repairing the defects around knee and within the upper 2/3 of lower leg.

Adult ; Female ; Humans ; Leg Injuries ; surgery ; Male ; Middle Aged ; Muscle, Skeletal ; transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the therapeutic effect of dorsal pentagonal flap for reconstruction of the web space in congenital syndactyly.

METHODSFrom October 2007 to August 2009, 10 patients with congenital syndactyly were treated with dorsal pentagonal flap for web space reconstruction. During the follow-up period, the patients underwent finger functional assessment and web space appearance examination. The satisfactory rate of patients was also investigated.

RESULTS10 patients with 17 reconstructed web spaces were followed up for 4-25 months (median, 15 months). Normal passive flexion and extension of fingers were achieved with good cosmetic result at web space. The abduction angle of fingers ranged from 30 degrees to 45 degrees. No web creep occurred and no secondary procedures were required. All the parents of the patients were satisfied with the results.

CONCLUSIONSWeb space reconstruction with dorsal pentagonal flap is easily performed with reliable blood supply and low re-operated rate. The cosmetic and functional result is satisfactory.

Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Surgical Flaps ; Syndactyly ; surgery ; Treatment Outcome

OBJECTIVETo discuss the therapeutic effect and clinical experience of a new technique of digital reconstruction with the free mesio-forearm flap based on perforator of ulnar artery.

METHODSWe marked the line from the pisiformis to the condylus medialis humeri as the axis of the flap. We used Doppler to detect the site of the mesio-forearm ulnar perforator which is usually 9-10 cm proximal to the condylus medialis humeri as center of the flap. We designed the flap that contained perforator artery with its accompanying vein of the ulnar artery and a superficial vein around the center spot along the axis of ulnar artery. The wound at donor site was sutured directly. Neurorrhaphy was not conducted in any cases.

RESULTSFrom June 2005 to June 2009, all 12 flaps survived with good quality and aesthetic contour. And no necrosis occurred. We conducted 6-36 months follow-up, and the result was satisfactory. The function of the fingers was reserved. Two-point discrimination differed from 6 cm to 12 cm.

CONCLUSIONSThe free ulnar perforator flap on mesio-forearm can repair digital defect with good therapeutic effect, leaving less morbidity at donor site.

Adolescent ; Adult ; Female ; Forearm ; surgery ; Hand Injuries ; surgery ; Humans ; Male ; Middle Aged ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome ; Ulnar Artery ; surgery ; Young Adult

OBJECTIVETo study the relation of the mRNA and protein expression of Cyclin A and p21cip1 in different stages hypertrophic scar fibroblast (FB) with its cell cycle, so as to provide theoretical evidence for intervention therapy of cell cycle gene being used in hypertrophic scar.

METHODSThe hypertrophic scar samples at different stages (the third month, the sixth month, the twelfth month, the twenty-fourth month) in 32 cases and the normal skin samples in 8 cases were used in this study. The expression of Cyclin A, p21cip1 mRNA and protein was detected by quantitative real-time PCR and Western Blot. And at the same time, the flow cytometer was used to detect the fibroblastic cell life cycle.

RESULTS1) The expression of Cyclin A mRNA and protein in the third month group, the sixth month group, the twelfth month group, the twenty-fourth month group were 19.34 +/- 2.41, 0.99 +/- 0.11; 19.30 +/- 1.42, 0.96 +/- 0.09; 10.73 +/- 2.93, 0.66 +/- 0.58; 9.29 +/- 0.97, 0.65 +/- 0.14, respectively. And in corresponding stages, the expression of p21cip1 mRNA and protein were 2.80 +/- 0.69, 0.35 +/- 0.07; 4.95 +/- 1.82, 0.44 +/- 0.07; 9.98 +/- 1.19, 0.56 +/- 0.06; 10.25 +/- 1.46, 0.59 +/- 0.06, respectively. The expression intensity of Cyclin A mRNA and protein was no significantly different between the third month group and the sixth month group (P > 0. 05), but it was higher respectively than that in the twelfth month group, the twenty-fourth month group and normal group (P < 0.05). And the expression intensity was no different between the above three groups (P > 0.05). The expression intensity of P21cip1 mRNA and protein in the third month group was lower than that in the sixth month group, but that in the above two groups was lower respectively than that in the twelfth month group, the twenty-fourth month group and normal group (P < 0.05). And the expression intensity had no difference between the three later stage groups (P > 0.05). 2) Most FB were in S and G2/M stage (cycle) in 3rd month, 6th month group. And most FB were in G0/G1 stage (cycle) in 12th month, 24th month group and normal group.

CONCLUSIONSThe expression of mRNA and protein of Cyclin A in hypertrophic scar changes from high level to low level as the hypertrophic scar develops, while the expression of P21cip1 changes from low level to high level. The mRNA and protein expression of Cyclin A and p21cip1 respectively are basically corresponded to different stages of hypertrophic scar. The distribution of cell life cycle of fibroblastic are also corresponded to the expression intensity of Cyclin A and p21cip1 in different stages hypertrophic scar. An early stage intervention to the two gene can be effective to prevent from the genesis and development of hypertrophic scar.

Adolescent ; Adult ; Cell Cycle ; Cells, Cultured ; Child ; Cicatrix, Hypertrophic ; metabolism ; pathology ; Cyclin A ; metabolism ; Cyclin-Dependent Kinase Inhibitor p21 ; metabolism ; Female ; Fibroblasts ; metabolism ; pathology ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo investigate the effect of adipose stromal vascular fraction cells (SVFs) on the survival rate of fat transplantation.

METHODS0. 5 ml autologous fat tissue was mixed with: 1) Di-labeled autologous SVFs ( Group A); 2) Di-labeled autologous adipose-derived stem cells (ASCs) (Group B); 3)Complete DMEM (Group C). And then the mixture was injected randomly under the back skin of 14 rabbits. The transplanted fat tissue in three groups was harvested at 6 months after implantation. Wet weight of fat grafts was measured for macroscopic aspects. After HE staining, blood vessel density, viable adipocytes and fibrous proliferation were counted respectively for histological evaluation. Trace of DiI-labeled ASCs in vivo was detected by fluorescent microscope.

RESULTSThe wet weight of fat grafts in group A (291.0 +/- 72.1) mg and group B (269.3 +/- 67.3) mg was significantly higher than that in group C (177.8 +/- 60.0) mg, but the difference between Group A and Group B was not significant. Histological analysis revealed that the fat grafts in group A and B was consisted predominantly of adipose tissue with less fat necrosis and fibrosis, compared with the fat grafts in group C. The grafts in both group A and B had significantly higher capillary density than those in the control group. Part of vascular endothelial cells were observed to origin from ectogenic DiI-labeled SVFs and ASCs.

CONCLUSIONSThe autologous isolated SVFs has a similar effect as autologous cultured ASCs to improve the survival rate of fat transplantation. And the former is more practical and safe, indicating a wide clinical application in the future.

Adipose Tissue ; cytology ; transplantation ; Animals ; Cells, Cultured ; Graft Survival ; Rabbits ; Stromal Cells ; cytology

OBJECTIVETo evaluate the effect of wound closure tension on the blood flow of the expanded pedicled fasciocutaneous flap, so as to find the best tension for the blood supply of the flap.

METHODS8 piglets, aged 9-12 months, were used. On each side of pig back, a cephalic based expanded fasciocutaneous flap was designed. The size of the flaps was 5 cm x 20 cm. In the control group, the flaps were not elevated (0 g tension). In the experimental group, the flaps were treated at the end with the tension of 100, 200, 300, 400, 500, 600, 700, 800, and 900 g after elevation. The blood oxygen saturation (StO2) of the flaps was measured under different wound closure tension.

RESULTSThe flap StO2 raised along the increase of tension until the tension reached 200-300 g. Then the flap StO2 decreased when the tension continued to increase above 200-300 g.

CONCLUSIONSThe tension of 200-300 g is good for the blood flow of expanded pedicled fasciocutaneous flap. So the flap flexibility can be best used and the complication can be avoided.

Animals ; Surgical Flaps ; blood supply ; Sus scrofa ; Swine ; Tensile Strength

OBJECTIVETo investigate the effect of Botulinum toxin type A (Botox) injection into the masseter muscle on mandibular development in rats.

METHODS12 28-day-old Wistar rats were divided into two groups as Botox group (n= 6) and control group (n = 6) which received anesthesia only. In Botox group, Botox was injected into the right masseter muscle, while only sterile saline into the left muscle. When the rats were 75-day-old, CT scan and 3D reconstruction were performed for cephalometry. The masseter muscles at both sides were weighed. Histologic study of masseter muscle and mandible was also performed.

RESULTSThe weight of right masseter muscle was (0.4575 +/- 0.0940) g in Botox group, and (0.8899 +/- 0.1030) g in control group (< 0.05). The mandibular height II and III was (10.8 +/- 0.8) mm and (9.5 +/- 0.6) mm in Botox group and (12.5 +/- 0.6) mm and (10.7 +/- 0.4) mm in control group, respectively (P < 0.05). The intergonial distance was (11.6 +/- 0.6) mm and (12.4 +/- 0. 6) mm in Botox and control group, respectively (P > 0.05).

CONCLUSIONSWhen the rats receive Botox injection into the masseter muscle at young age, the grown-up rats have a decreased mandibular height, but the mandibular length and intergonial distance are not affected.

Animals ; Botulinum Toxins, Type A ; administration & dosage ; pharmacology ; Injections, Intramuscular ; Male ; Mandible ; drug effects ; growth & development ; Masseter Muscle ; Rats ; Rats, Wistar

OBJECTIVETo study the ultrastructure and Ca/P element spectrometry of distraction osteogenesis (DO) for reconstruction of cleft palate (CP), so as to explore the osteogenesis and remodeling of new bone in situ.

METHODS23 rhesus macaques were operated to establish animal models of CP. 2 monkeys didn't received DO as controls. The other 21 monkeys in experimental group underwent DO to correct both bony and soft tissue defects in palate. The distraction was performed at a rate of 0.8 mm/d, twice a day until the cleft was closed. After fixation for 1, 2, 4, 6, 8, 12, 24 weeks, every 3 animals were sacrificed to get the specimens at the distraction gap. The scanning electron microscopic study and Ca, P elements spectrometric analysis were adopted. There were also two unoperated animals as sham group.

RESULTSAfter fixation for 1-2 weeks, the distraction gap was full of collagen fibers oriented along vector of distraction. Few trabeculae was seen at the margin area. After fixation for 4-6 weeks, active osteogenesis was presented with new formed bone trabeculae and abundant cellular component. After fixation for 8-12 weeks, the new formed bone became mature and couldn't distinguish from the normal bone. 24 weeks later, the bone between the distraction gap had a similar structure to the normal bone. Elements spectrometric analysis results indicated that in early stage of osteogenesis, the P and S peaks were relatively high while the Ca peak was much lower. During the late stage, the S peak was obviously decreased, and Ca/P ratio increased to normal level as in the empty control group.

CONCLUSIONSThe CP can be corrected by DO. The new bone between the distraction gap is formed and remodeled through intramembraneous osteogenesis.

Animals ; Cleft Palate ; metabolism ; pathology ; surgery ; Disease Models, Animal ; Female ; Macaca mulatta ; Male ; Microscopy, Electron, Scanning ; Osteogenesis ; Osteogenesis, Distraction ; methods ; Palate ; surgery ; ultrastructure

OBJECTIVETo evaluate the long-term therapeutic effect and histologic result of ADM combined with autologous thin split-thickness skin graft.

METHODS23 patients were treated with acellular dermal matrix (ADM) combined with autologous thin split-thickness skin graft. The patients were followed up at 3, 6, 12, and 18 months after operation. The histological analysis was also performed.

RESULTS3, 6, 12, 18 months after operation, the composite skin grafts became smooth with no hypertrophic scar and hyperpigmentation. It was soft and elastic. The joints could move randomly. The histologic study showed the composite skin graft had a similar appearance as the normal skin.

CONCLUSIONAs for the treatment of wound, the composite skin graft with ADM is smooth and soft with good elasticity after transplantation, but it has no perspiration.

Adolescent ; Adult ; Child ; Child, Preschool ; Dermis ; transplantation ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Skin Transplantation ; methods ; Skin, Artificial ; Transplantation, Autologous ; Young Adult

OBJECTIVETo evaluate the effect of tumescent infiltration solution temperature on core body temperature after liposuction.

METHODS15 healthy female subjects were randomly divided into 2 groups to receive tumescent infiltration solution at 25 degrees C as group A, or at 37 degrees C as group B. All subjects were under epidural anesthesia. Vital signs, including core temperature, heart rate, respiratory rate and blood pressure, were monitored immediately, 1 hour, 2 hours, 3 hours, 4 hours and 8 hours after operation.

RESULTSThe core body temperature immediately, 1 hour, 2 hours and 3 hours after operation were (35.8 +/- 0.5) degrees C, (35.8 +/- 0.5) degrees C, (36.0 +/- 0.5) degrees C, (36.1 +/- 0.5) degrees C in group A, and (36.5 +/- 0.4) degrees C, (36.5 +/- 0.3) degrees C, (36.5 +/- 0.3) degrees C, (36.6 +/- 0.4) degrees C in group B, showing a significant difference between the two groups (P = 0.008, P = 0.008, P = 0.03, P = 0.033, respectively). There was no difference in body temperature 4 hours and 8 hours after operation and in heart rate, respiratory rate and blood pressure between the two groups (P > 0. 05).

CONCLUSIONSThe tumescent infiltration solutions at room temperature (25 degrees C) can decrease the core body temperature and increase surgical risk. It might not be good for rehabilitation. It is recommended to use tumescent infiltration solution at body temperature (37 degrees C) in liposuction.

Adult ; Body Temperature ; Female ; Humans ; Lipectomy ; methods ; Middle Aged ; Postoperative Period ; Solutions ; Temperature ; Young Adult