1.Reconstruction of skin defects around the Achilles tendon with rectangle advancement flap in children
Yang LIU ; Jitang ZHAO ; Shuwei TIAN ; Lianxin SONG ; Chunsheng WU ; Aqin PENG ; Yanlong ZHANG
Chinese Journal of Orthopaedic Trauma 2017;19(6):537-539
Objective To explore the clinical efficacy of rectangle advancement flaps used in the reconstruction of skin defects around the Achilles tendon in children.Methods From May 2014 to June 2015,7 children with skin defects around the Achilles tendon were admitted to our trauma center.The areas of skin defect ranged from 3.4 cm × 2.7 cm to 5.5 cm × 4.0 cm.The integrity of Achilles tendon was preserved in 6 cases but the tendon insertion was partly disrupted in one case.The skin defects were reconstructed with self-designed rectangle advancement flaps after debridement.In the one case with the Achilles tendon partly disrupted,the contaminated tendon ends were excised before wound closure.The injured ankles were immobilized in plantar flexion with one 1.5 mm K-wire and plaster splint to decrease the postoperative tension of the flap.Results All the flaps survived completely by primary intention but local infection occurred in 2 wounds which was cured by second intention of dressing change.The follow-up periods ranged from 8 to 12 months (average,11.5 months).The scar around the flap was remarkable in 2 cases,but the flaps in the other cases appeared normal in terms of color and texture.The ankle function was satisfactorily normal in all the cases.Conclusion Our self-designed rectangle advancement flaps provide a simple,safe and reliable way to repair skin defects around the Achilles tendon in children.
2.Semi-open cancellous bone grafting for infected bone defect combined with soft tissue defect of lower limb
Tianhao WU ; Yanlong ZHANG ; Yong WANG ; Xiao ZHANG ; Shuwei TIAN ; Xirui WU ; Aqin PENG
Chinese Journal of Trauma 2019;35(2):101-108
Objective To investigate the clinical efficacy of semi-open cancellous bone grafting for infected bone defect combined with soft tissue defect of lower limb.Methods A retrospective case control study was conducted to analyze the clinical data of 26 patients with infected bone defect combined with soft tissue defect of lower limb admitted to the Third Hospital of Hebei Medical University from March 2010 to August 2017.There were 16 males and 10 females,aged 16-65 years [(39.6 ± 12.8)years].The bone defect area before bone grafting was 1.4-6.0 cm [(3.3 ± 1.2) cm].The surface soft tissue defect of bone graft granules was 2.3 cm × 1.1 cm-8.5 cm × 5.0 cm after bone grafting.If the defect was segmental defect of more than 6 cm,the defect was firstly reduced by bone transport.When the defect was near the docking point,the bone defect was repaired by open bone grafting.If the defect was located at the metaphyseal end of the calcaneus or tibia,stage Ⅰ or stage Ⅱ open bone grafting was performed after debridement.After bone grafting,antibiotic-containing cement sheets were used to cover the wound in 14 patients (semi-open group),and vacuum sealing drainage (VSD) devices were used to cover the wound in 12 patients (VSD group).The time of granulation tissue covering bone graft granules,wound healing time,bone defect healing time,material cost and complications (wound infection and necrosis of bone graft granules) were compared between the two groups.The limb function was evaluated according to Paley score.Results All patients were followed up for 12-40 months [(19.3 ±7.2) months].In the semi-open group and VSD group,the time of granulation tissue coverage was 22.2 days (15.0-44.0) days and 20.2 days (15.0-44.0) days (P > 0.05);wound healing time was 3.1 months (1.5-5.5) months and 3.1 months (1.5-6.5) months (P > 0.05);bone defect healing time was (5.5 ± 2.2) months and (5.9 ± 2.4) months (P > 0.05);the cost of covering wound materials was (2 056.1 ± 23.4) yuan and (5 555.3 ± 1 105.5) yuan respectively (P < 0.05).No wound infection occurred in either group.Two patients in the semi-open group and one patient in the VSD group had bone graft granules surface necrosis (P >0.05).According to Paley's functional score,the results were excellent in 12 patients and good in two in the semiopen group,compared with excellent in 11 and good in one in the VSD group (P > 0.05).Conclusion For infected bone defect combined with soft tissue defect of lower limb,semi-open bone grafting can simplify the nursing of wound,prevent wound infection,promote wound healing and fracture healing.It has similar therapeutic effect with VSD,but its treatment cost is significantly reduced.
3. Clinical effect of nano-fat mixed granule fat transplantation in the treatment of cicatricial facial depression and atrophy and the related experimental mechanism
Yanlong ZOU ; Xi TAN ; Ting TIAN ; Le LI ; Zhexu LI ; Wei CHENG ; Zhenxiang WANG
Chinese Journal of Burns 2019;35(4):266-276
Objective:
To study the clinical effect of nano-fat mixed granule fat transplantation in the treatment of cicatricial facial depression and atrophy, and to explore the related experimental mechanism.
Methods:
(1) From January 2012 to April 2018, 105 patients conforming to the inclusion criteria, with cicatricial facial depression and atrophy deformity who needed facial fat transplantation, were admitted to our unit. Their medical records were analyzed retrospectively. According to the patients′ wishes, 54 patients (12 males and 42 females) aged 10-59 years received traditional transplantation of pure autologous granule fat collected from abdomen/thigh and were included in simple transplantation group, while the other 51 patients (14 males and 37 females) aged 7-63 years received transplantation of autologous nano-fat mixed granule fat collected from abdomen/thigh and were included in mixed transplantation group. The treatment satisfaction of patients 3 and 6 months after operation was assessed by the facial fullness, symmetry, scar, and complications using self-made scales and photo data before and after operation. Six months after operation, the patients were assessed whether they needed to undergo a second operation, and the rate of second operation was calculated. During the second operation, the fat of patients transplanted in the first operation was collected, and the morphology of adipocytes and microangiogenesis was observed under a scanning electron microscope. (2) Adipose-derived stem cells (ADSCs) were isolated and cultured from abdominal fat of a 4-week-old male Sprague-Dawley (SD) rat. The 5th passage of cells were selected to observe cell morphology after cultured for 14 days, observe expression of vimentin and cytokeratin-18 by immunofluorescence method, identify osteogenic and adipogenic differentiation, and detect rates of CD29 and CD44 positive cells by flow cytometer (
4. The application of hybrid operation suite in the management of cerebral and spinal vascular diseases and intracranial hypervascular tumors
Peiliang LI ; Jianping SONG ; Wei ZHU ; Yanlong TIAN ; Liang CHEN ; Qingzhu AN ; Gong CHEN ; Bin XU ; Yuxiang GU ; Bing LENG ; Ying MAO ; Liangfu ZHOU
Chinese Journal of Surgery 2019;57(8):607-615
Objective:
To evaluate the effect of hybrid operation suite in the treatment of cerebral and spinal vascular diseases and intracranial hypervascular tumors.
Methods:
A retrospective study was conducted on 132 patients with various cerebral and spinal vascular diseases and intracranial hypervascular tumors who were treated by hybrid surgery at Department of Neurosurgery, Huashan Hospital from October 2016 to December 2017.There were 70 male and 62 female patients with a mean age of 48.33 years (range: 14-78 years), including 64 cases of intracranial aneurysm (41 complicated aneurysm cases), 28 cases of brain arteriovenous malformation (BAVM), 12 cases of hypervascular tumor, 12 cases of dural arteriovenous fistula (DAVF), 6 cases of carotid artery stenosis, 5 cases of Moyamoya disease, 3 cases of intracranial aneurysm or BAVM combined with tumor, 1 case of scalp arteriovenous fistula and 1 case of critical brain trauma in which a foreign metal stick approached the basal vascular circuit.Abnormalities were found in 16 cases in intraoperative angiography. The clinical data of all patients was collected as a perspective cohort. The success rate of hybrid surgery, intra-operative and post-operative complications, morbidity, mortality, rate of infection, the length of hospital stay were all analyzed to illustrate the effect of hybrid operation mode to traditional surgical pattern.
Results:
For 64 cases with intracranial aneurysms, the immediate complete occlusion rate was 90.5%, with a mortality of 4.7% and a morbidity of 14.0%. For 28 cases of BAVM and 12 cases of DAVF, all patients achieved total obliteration and favorable social independent outcomes after hybrid surgery, with no complication.For 6 cases of carotid artery stenosis and 5 cases of Moyamoya, intra-operative confirmed good cerebral reperfusion without any new post-operative neurologic deficits. After tumor vessels embolization, 4 out of 12 cases of hypervascular tumor needed intra-operative blood transfusion, and all patients achieved total tumor resection in a single stage. Only one patient with medulla oblongata hemangioblastoma died 6 months after operation due to respiratory deficit related pneumonia. Compared to traditional surgeries, the hybrid operation pattern did not significantly increase the total infection rate, central nervous system infection rate, hospital stay days and post-operative hospital stay days (all
5.Effects of interleukin (IL)-10/ transforming growth factor (TGF)-β-modified macrophages on renal ischemia reperfusion injury
Yanlong ZHAO ; Puxun TIAN ; Jin ZHENG ; Chenguang DING ; Yi GAO ; Wujun XUE ; Xiaoming DING ; Jing LIU ; Feng HAN ; Xinxin XIA
Chinese Journal of Organ Transplantation 2017;38(12):734-740
Objective To investigate the effects of IL-10/TGF-β-modified macrophages on renal ischemia reperfusion injury (IRI).Methods Bone marrow-derived macrophages were modified ex vivo by IL-10/TGF-β to acquire M2c (a subset of activated macrophages).M2c were transferred into treated C57BL/6 mice by a single tail-vein injection at 6 h after renal IRI.Mice were killed on the day 3 after renal IRI.Blood samples were collected to check renal function.Kidneys were harvested to determine tubular necrosis and apoptosis by H&E staining and TUNEL assay.Immunofluorescence was performed to analyze the proliferating tubular cell nuclear antigen.Meanwhile,proinflammatory cytokines and regulatory T cells in renal tissues were analyzed with real-time PCR and flow cytometry.Results In comparison with M1,M2c expressed lower levels of MHC Ⅱ (P<0.01),CD86 (P< 0.01),TNFα (P<0.01) and IL-1β (P<0.01) and higher level of IL-10 (P<0.01).M2c significantly attenuated renal functional decline (P<0.01 or 0.05),structural injury (P<0.05),apoptosis of tubular cells (P<0.01) and inflammation factors infiltration (P<0.01 or 0.05).What's more,the cells could promote tubular cells proliferation (P<0.05) and regulatory T cells expression (P<0.01).Conclusion Our results demonstrated that M2c macrophages effectively protect against renal IRI and may become a therapeutic strategy for renal IRI.
6.Successful management of intramedullary nail associated infection with reaming and antibiotic cement beads/rod
Yanlong ZHANG ; Chenchen FENG ; Shuwei TIAN ; Yong WANG ; Aqin PENG
Chinese Journal of Orthopaedics 2018;38(9):523-529
Objective To assess the efficacy of using reaming and antibiotic cement beads/rod for intramedullary nail associated infection.Methods Data of 12 patients with intramedullary infection of tibia or femur following intramedullary nailing from October 2014 to April 2016 were retrospectively analyzed.There were 10 men and 2 women aged from 19 to 63 years old with an average age of 39.2 years.In 5 cases the disease was localized in the femur with one case of nonunion,and in other 7 cases the disease was localizedin the tibia with two cases of nonunion.The initial injury included closed fracture in 8 patients and open fracture in 4 patients which were all Gustilo-Anderson Ⅱ.According to the Cierny-Mader classification of adult osteomyelitis,6 cases were type Ⅰ (medullary osteomyelitis),4 cases were type Ⅰ combined with type Ⅲ (medullary.and localized osteomyelitis),and 2 cases were type Ⅰ combined with type Ⅳ (medullary and diffuse osteomyelitis).Surgical technique included removal of the intramedullary nailand reaming and irrigation of the medullary canal to remove intramedullary debris.The drainage sinus and soft tissues abscess were excised if existed.An local or enbloc resection for the infected or necrotic bone was performed if there was local or diffuse infection in the fracture sites.Ilizarov technique was performed for segment bone defect.The bone union was observed in nine patients and stable nonunion in one.Antibiotic PMMA beads were inserted into intramedullary canal for these ten cases after debridement,and the antibiotic beads were removed approximately 12-14 days after implantation.The antibiotic cement rod was inserted into the medullary canal to provide stabilization in the other 2 cases.All the patients received intravenous antibiotics systemically for three weeks,and followed by three weeks of oral antibiotics.Results At a mean follow-up period of 23.5 months (range,15-33 months),no recurrence of infection was observed.There were 3 cases of nonunions.One case of tibial nonunion had been achieved union 10 months after insertion of an antibiotic cement rod.One with stable nonunion of tibia was treated with antibiotic PMMA beads,and enbloc resection for the infected bone was performed after the extension of infection had been narrowed at the nonunion.6 cm of bone defect was treated with bone transport and then union was obtained 16 months after operation.The third case was infected nonunion in the femur with 4 cm bone defect after debridement.The femur was shortened and temporarily stabilized with the intramedullary antibiotic cement rod.The rod was removed three months after the operation,and then the femur was lengthened.The docking site and the regeneration area were healed 12 months after the lengthening operation.Conclusion The clinical results shows that reaming and antibiotic cement beads/rod appears an effective and safe alternative for management of intramedullary nail associated infection of the tibia and femur.
7.Application of 3.0T intraoperative high-field magnetic resonance imaging guidance for the surgery of arteriovenous malformation within eloquent areas.
Fengping ZHU ; Yanlong TIAN ; Wei ZHU ; Yuxiang GU ; Bin XU ; Jinsong WU ; Ying MAO ; Liangfu ZHOU
Chinese Medical Journal 2014;127(6):1180-1182
Adult
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Arteriovenous Malformations
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diagnosis
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surgery
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Female
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Humans
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Magnetic Resonance Imaging
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methods
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Male
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Middle Aged
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Young Adult