1.Application of free chimeric perforator flap with deep epigastric inferior artery for the soft tissue defect on the lower extremity with deep dead space.
Tang JUYU ; Qing LIMING ; Wu PANFENG ; Zhou ZHENGBING ; Liang JIEYU ; Yu FANG ; Fu JINFEI
Chinese Journal of Plastic Surgery 2015;31(6):425-428
OBJECTIVETo explore the feasibility and the effect of free chimeric perforator flap with deep inferior epigastric artery for the soft tissue defect on the lower extremity with deep dead space.
METHODSFrom Mar. 2010 to Aug. 2011, 8 patients with soft tissue defects on the lower extremities combined with dead space, bone or joint exposure were reconstructed with free hinged perforator flaps with deep inferior epigastric artery. The muscle flap was inserted into the deep dead space, with perforator flap for superficial defect. The defects on the donor sites were closed directly.
RESULTSAll the flaps survived with primary healing. Good color and texture was achieved. The patients were followed up for 12-24 months, with an average of 16 months. 2 over-thick flaps were treated by flap-thinning surgery. Only linear scar was left on the donor site on abdomen with no malfunction.
CONCLUSIONSThe free chimeric perforator flap with deep inferior epigastric artery can simultaneously construct the dead space and superficial defect with only anastomosis of one set of vascular pedicle. It is an ideal method with good results on recipientsites and less morbidity on donor sites.
Cicatrix ; Epigastric Arteries ; transplantation ; Feasibility Studies ; Follow-Up Studies ; Humans ; Leg Injuries ; surgery ; Lower Extremity ; Perforator Flap ; transplantation ; Soft Tissue Injuries ; surgery ; Time Factors ; Wound Healing
2.Therapeutic effect of bone marrow mesenchymal stem cells transplanted through intraarterial route after cerebral ischemia in rats
Xiaomu WU ; Xinhui QU ; Honglian ZHANG ; Gang HUANG ; Zhengbing XIANG ; Ji ZHANG ; Shimin LIU ; Kunnan ZHANG
Chinese Journal of Neurology 2011;44(7):487-492
Objective To investigate the therapeutic effect and the detailed mechanisms of intraarterially delivery of bone marrow mesenchymal stem cells ( BMSCs) for treatment of middle cerebral artery occlusion (MCAO) in rats.Methods BMSCs were isolated,purified and amplified with the adherence culture method.BMSCs were labeled with 5-bromo-2-deoxyuridine ( BrdU ) (10 μmol/L) for 48 h before transplation.Surface antigens of CD90,CD29,CD106,CD34,CD45,CD11b were identified by flow cytometry.The MCAO model was established with suture emboli method.In this study,3×106 BMSCs were injected into rats with MCAO through intraarterial route at day 7 after stroke.The effects on functional and physical recovery were assessed with the behavioral tests (mNSS test and adhesive test) and body weight.Bielshowsky-Luxol Fast Blue double staining was used to demonstrate the reconstruction of axon and myelin.The Brdu-labeled BMSCs in vitro and in vivo were detected with direct immunofluorescent staining.The expression of neuron specific enolase ( NSE),neurite outgrowth inhibitor-A ( Nogo-A),synaptophysin (SYN),ki-67 nuclear antigen (Ki-67),glial fibrillary acid protein( GFAP),vascular endothelial growth factor ( VEGF) in brain were analyzed with immunohistochemical staining.Results Flow cytometry indicated that the positive rates of high expression of CD90,CD29,CD106 in BMSCs were respectively 91.70%,88.40% and 52.20%.Meanwhile,the positive rates of low expression of CD34,CD45,CD11b in BMSCs were 2.70%,5.65% and 7.82%,respectively.There was a significant difference in behavioral tests ( mNSS test and adhesive test) between BMSCs group and PBS group at day 21,28,35 after MCAO (mNSS:4.89 ±1.36,7.00 ±1.67,3.78 ±1.30 and 6.33 ±1.21,2.44 ±1.13,5.67 ± 1.51;t =2.69,3.83,4.75;adhesive test:54.00 ± 10.48,68.17 ± 11.09,36.89 ±9.80 and 59.33 ± 12.40,23.44 ± 9.04,46.50 ±9.38;t =2.51,3.92,4.77;P <0.05).Meanwhile,a significant difference in body weight was discovered between them at day 28,35 after MCAO.In BMSCs group,the area of corpus callosum in the ipsilateral hemisphere was significantly enlarged,the positive number of Brdu,SYN,Ki-67,GFAP,VEGF in brain was significantly increased,the expression of Nogo-A in brain was significantly decreased,nevertheless,the number of NSE-positive cells in brain and the infarct volume were not significant different from PBS group at day 35 after MCAO.Conclusions These results suggest that intra-arterial transplantation of BMSCs is an efficient treatment protocol for stroke.Treatment with BMSCs increases endogenous cells proliferation,angiogenesis,synaptogenesis,enhances axonal regeneration and the protective function of astrocytes,all of which may contribute to neurological functional recovery.
3.A reliable parameter for primary closure of the donor site of the descending branch of the circumflex femoral lateral artery perforator flap and analysis its effective factors
Liming QING ; Jiqiang HE ; Juyu TANG ; Panfeng WU ; Zhengbing ZHOU ; Fang YU
Chinese Journal of Microsurgery 2017;40(2):114-117
Objective To explore a reliable parameter for primary closure of the donor site of the descending branch of the circumflex femoral lateral artery perforator flap and analysis its effective factors.Methods Between August,2014 and December,2015,149 patients undergoing reconstructive procedures using the descending branch of the circumflex femoral lateral artery perforator flaps were included in the study.All patients were divided into two groups:primary closure of the donor site (135 cases) and none primary closure of the donor site (14 cases).The receiver operating characteristic curve for biostatistical analysis was performed to identify the reliable width of the descending branch of the circumflex femoral lateral artery perforator flap.The parameter,including the age,patients' body mass index,subcutaneous fat thickness,thigh circumference and the maximum flap width,were recorded in 79 patients who were randomly choose from all patients.The method through stretching donor site skin was used to assess the maximum flap width.The maximum flap width-to-thigh circumference ratio was calculated.The Pearson test was used to analysis the correction between those parameters.Results Primary closure of the donor site was possible in 135 patients and impossible in 14 patients.The receiver operating characteristic curve for biostatistical analysis identifying the reliable width of the descending branch of the circumflex femoral lateral artery perforator flap was 8.75cm.The method assessed the reliable width of the flap was (8.37±1.67) cm through stretching donor site skin.the reliable width of the flap was (8.55±1.65) cm in the male patients and (7.42±1.5) cm in the female patients.There was significant different between the two group (P < 0.05).Primary closure can be achieved if the flap width-to-thigh circumference ratio was less than (17.23±3.84) percent.There was a significant negative correlation between subcutaneous fat thickness and the ratio (R=-0.299,P < 0.05) and between body mass index and the ratio (R=-0.21,P < 0.05).Conclusion The width of flap less than 8.75 cm is a reliable parameter for primary closure of the descending branch of the circumflex femoral lateral artery perforator flap donor site.The patient's body mass index and subcutaneous fat thickness of the thigh should be taken into consideration.
4.Vascularized chimerical perforator flaps of deep circumflex iliac artery repairing bone and soft tissue defects of limbs
Panfeng WU ; Juyu TANG ; Kanghua LI ; Jieyu LIANG ; Fang YU ; Zhengbing ZHOU
Chinese Journal of Microsurgery 2014;(6):524-527
Objective To explore the clinical effect and experience of separating deep circumflex iliac artery osteocutaneous perforator flap (DCIAP) from the bone flap.Methods According to local applied anatomy of groin,vascularized chimerical flaps of deep iliac circumflex artery was designed and applied.From May,2008 to June,2012,12 patients who combined bone and composite skin and soft-tissue defects were positioned by color dopplar ultrasound before operation and treated with vascularized chimerical flaps of deep iliac circumflex artery.The deep circumflex iliac perforator flaps was 8 to 19 cm in length and 2 to 6 cm in width,and the iliac bone grafts ranged from 5 to 8 cm in length.Results All flaps were fully survival.After 8-10 months postoperative followed-up,all the bone defect gained healing.The function and appearance of cutaneous flaps were satisfactory.There was no serious complication in donor sites of groin.The average time of healing was 9 (8-10) months.Conclusion Vascularized iliac bone graft and a perforator flap are nourished by the same deep circumflex iliac artery.There is more mobile scope and only 1 blood vessel between the bone graft and skin flap,which should be called chimeric perforator flap based on the deep iliac circumflex artery,and is a kind of good method to repair bone and soft-tissue defects of limbs.
5.Clinical application of the polyfoliate perforator flap with decending branch of the lateral circumflex femoral artery: 16 cases report
Panfeng WU ; Juyu TANG ; Kanghua LI ; Jieyu LIANG ; Fang YU ; Zhengbing ZHOU
Chinese Journal of Microsurgery 2015;38(6):526-529
Objective To describe a technique to achieve primary donor-site closure, extend applications and minimize donor-site morbidity by applying the double skin paddle principle.Methods All 16 cases of the double skin paddle anterolateral thigh perforator flap reconstruction from May, 2008 to June, 2014 were reviewed.Defects locations included calf, dorsum pedis or planta pedis.A long anterolateral thigh perforator flap was marked out using standard points of reference.At least two separate cutaneous perforator vessles were identified on hand-held Doppler.Separating and dissecting flap at superficial layer of fascia lata was adopted in all cases.Then skin paddle was then divided between the two cutaneous perforators to give two separate paddles with a common vascular supply which was the descending branch of the lateral circumflex femoral artery.The skin paddles could be used to cover complex skin defects, whilst still allowing for primary donor-site closure.Results Fifteen patients were successfully treated with the double skin paddle anterolateral thigh perforator flap with no major complications.One case was suffered with partial skin flap necrosis.The type A dumbbell-like flaps was used to cover defects involving two different units of the foot.The type B pattern were stacked side by side on a flap inset, effectively doubling the width of the flap, to resurface a large defect of a single unit of the calf.The type C pattern was used to repair adjacent skin defects.In all cases, the donor site was closed directly.All patients were satisfied with their outcomes.Conclusion The double skin paddle anterolateral thigh perforator flap is an excellent method of resurfacing large defects of the extremity involving multiple subunits with improved morbidity and cosmesis of the donor site.
6.A novel surgical technique for dissecting perforator vessel in anterolateral thigh perforator flap: Orderly retrograde four-side dissection
Juyu TANG ; Liming QING ; Panfeng WU ; Zhengbing ZHOU ; Fang YU ; Xiaoyang PANG ; Ding PAN ; Lei ZENG ; Yongbing XIAO ; Rui LIU
Chinese Journal of Microsurgery 2021;44(2):137-140
Objective:To introduce a novel surgical technique for dissecting perforator vessels (orderly retrograde four-side dissection) in anterolateral thigh perforator flap (ALTPF) and explore its clinical outcome.Methods:Respective analysis of 94 patients who underwent reconstruction of soft tissue defects with ALTPF which were dissected by orderly retrograde four-side dissection between June, 2013 and December, 2016. After surgery, the survival of flaps, recovery in shape and function of the recipient sites, and the effect on shape and function of the donor sites were observed.Results:The size of ALTPF ranged from 7 cm×5 cm to 32 cm×10 cm. Ninety-four perforators were included in 94 ALTPF, which were 89 perforators of the descending branch of circumflex femoral lateral artery, 4 perforators of the transverse branch of circumflex femoral lateral artery and 1 perforator of femoral medial artery. The time for flap harvesting was 35-95(54.39±16.39) min. Success rate of perforator harvesting was 98.9%, only 1 perforator was injured and another encountered vasospasm during surgery. Three cases had vascular crisis after flap transfer with 2 venous crises and 1 artery crisis. All of the flaps completely survived except 1 that had a partial necrosis. The follow-up time was (12.91±9.17) months. No muscular weakness on donor sites was shown in all cases.Conclusion:Orderly retrograde four-side dissection of perforator vessels in the ALTPF has achieved less donor site morbidity, shorter surgical time and is safer than the traditional techniques. It is a reliable technique to harvest perforator flaps.
7.Clinical Efficacy of 30 Cases about Filiform-fire Needle Combined with Abdominal Acupuncture Therapy in Ankylosing Spondylitis
Journal of Zhejiang Chinese Medical University 2018;42(3):247-250
[Objective] To observe the clinical effects of filiform-fire needle combined with abdominal acupuncture in treating ankylosing spondylitis(cold-dampness syndrome). [Methods] Sixty patients who met the criteria of AS were included in the study. They were randomly divided into treatment group and control group for 30 patients in each group. The patients of control group were treated with Diclofenac sodium sustained -release tablet and Salazosul-fpyridine intestinal solution, while treatment group were treated with filiform-fire needle combined with abdominal acupuncture on the basis of western medicine mentioned above.All patients were treated and observed for three months, and they were evaluated by score of TCM symptoms, thoracic activity, spinal activity, finger-floor distance, pillow-wall distance and blood parameters, such as C-reactive Protein(CRP), Erythrocyte Sedimentation Rate (ESR)and Immune Globulin A(IgA). [Results] The total effective rate in treatment group was higher than that in control group(P<0.05).After treatment, the two groups all got lower scores of TCM symptoms than before, and the scores of the treatment group were significantly lower than the control group(P<0.05).The thoracic activity, spinal activity, finger-floor distance and pillow-wall distance of all patients improved in varying degrees, and the blood parameters of CRP, ESR and IgA decreased compared with that before treatment, and significantly the treatment group was superior to control group(P<0.05).[Conclusion] The filiform-fire needle combined with abdominal acupuncture can effectively relieve pain, improve functional activity of the spine and peripheral joints, reduce inflammation, slow disease progression and raise the quality of life of the patients.
8. Reconstruction of the soft-tissue defects of the limbs in children by free circumflex scapular artery perforator flap
Panfeng WU ; Juyu TANG ; Zhengbing ZHOU ; Fang YU ; Xiaoyang PANG ; Lei ZENG ; Ding PAN ; Yongbing XIAO ; Liming QING ; Rui LIU
Chinese Journal of Plastic Surgery 2018;34(9):698-704
Objective:
To explore the feasibility of free circumflex scapular artery perforator flap for repairing the wounds of the limbs in children.
Methods:
From April, 2010 to October, 2017. 39 cases of pediatric patients who suffered from skin and soft defects in the limbs with exposure of bone, joint or tendon were repaired by the circumflex scapular artery perforator flap.The flap size ranged from 6.0 cm×3.5 cm to 16 cm×14 cm. Doppler detection was used to determine the distribution of the descending, ascending and transverse branches of the circumflex scapular artery. The proper perforator flap type was selected according to the shape and the size of the wound.
Results:
Thirty-seven flaps survived smoothly. Venous crisis occurred in one case and arterial crisis occurred in another case at the second postoperative day. Both flaps survived completely after exploration. All flaps were healed at the recipient sites. Delayed healing of the donor site wound occurred in two cases. All cases were followed up for 3 to 36 months (average 12 months), and the appearance and function of the recipient sites were satisfactory. Only linear scars remained in the donor sites.
Conclusions
The free circumflex scapular artery perforator flap is an ideal method to resurface the soft-tissue defects of extremities in children.
9. The clinical application of individual design deep inferior epigastric perforator flap for resurfacing the various types of soft tissue defects in extremities
Liming QING ; Juyu TANG ; Panfeng WU ; Zhengbing ZHOU ; Fang YU ; Xiaoyang PANG ; Ding PAN ; Lei ZENG ; Yongbing XIAO ; Rui LIU
Chinese Journal of Plastic Surgery 2018;34(9):709-714
Objective:
To explore the feasibility and efficiency of deep inferior epigastric perforator flap (DIEP) based on individual design which was used for reconstructing the various types of soft tissue defects in extremities.
Methods:
From September 2009 to October 2017, ninety three patients were included for respective analysis who presented with bone and tendon exposure or dead space, and reconstructed through individualized DIEP flaps in our department. We evaluated the appearance of donor site according to patients′satisfaction.
Results:
Eight patients had pedicle DIEP flaps, 47 patients were treated with free traditional DIEP flaps, and 38 cases underwent with special forms of DIEP flaps. The special forms of DIEP flaps included 8 chimeric DIEP flaps, 13 dual skin paddles DIEP flaps, 12 microdissection DIEP flaps, 1 conjoined DIEP flap, 2 flow-through DIEP flaps, 1 mutipaddles chimeric DIEP flap and 1 microdissection dual skin paddles DIEP. The size of flap ranged from 7 cm×4 cm to 36 cm×11 cm. All of the donor sites were primarily closed.Most of flaps survived, only two cases suffered with necrosis due to vascular crisis. Those patients have been followed-up from 5 to 24 months (average 12.4 months). A good color and texture were achieved in most of recipient sites. 16.1% of patients needed the second debulking procedure. The function of abdominal wall was normal postoperatively. Transverse flap design was performed for 32 patients, oblique design for 46 patients, irregular design for 13 patients, and longitudinal design for 2 patients. The rate of excellent donor site appearance was 86.9% in the transverse designed flaps, 70.0% for the donor site with the oblique designed flap, and 37.5% for the donor site with the irregular designed flap.
Conclusions
The individualized DIEP flaps based on different wound characteristics are ideal approaches for reconstruction of various types of soft tissue defects in extremities.
10. Radial collateral artery perforator flap combining a vascularized fragment of the distal humerus in reconstruction of thumb complex defects
Fang YU ; Juyu TANG ; Panfeng WU ; Zhengbing ZHOU ; Xiaoyang PANG ; Lei ZENG ; Yongbing XIAO ; Ding PAN ; Liming QING ; Rui LIU
Chinese Journal of Plastic Surgery 2019;35(9):887-891
Objective:
To explore the efficiency and effect of radial collateral artery chimeric perforator flap combining a vascularized fragment of the distal humerus to reconstruct thumb complex defects.
Methods:
5 cases of thumb complex tissue defects patients admitted to Xiangya Hospital of Central South University from June 2014 to October 2018. The patients were all male and aged from 35 to 63 years (average age was 47 years). There were 2 cases of right thumb and 3 cases of left thumb. The skin defect area was from 16.0 cm×4.0 cm to 3.5 cm×2.0 cm, and the bone defect length was 2-3 cm.All defects were reconstructed with radial collateral artery chimeric perforator flap combining a vascularized fragment of the distal humerus. The sizes of perforator flap were from 4 cm×2 cm to 18 cm×5 cm, and the sizes of bone were from 2.0 cm×0.6 cm×0.5 cm to 2.5 cm×1.0 cm×0.5 cm.The posterior branchial cutaneous of the arm was included in skin flap. 2 flaps underlied microdissect to defat. After fixing bone flap and finger/metacarpal bone with Kirschner wires, the radial accessory vessels were anastomosed with the radial vessels and cephalic vein at the nasopharyngeal fossa.All donor sites were closed directly.
Results:
All flaps survived uneventfully. Kirschner wires were removed 4 to 6 weeks after operation. Postoperative follow-up ranged from 3 months to 4.5 years (average 19 months). All bone aps healed without union. Functions of thumb opposition and thumb to finger were all good. The hand function had excellent result in 3 cases and good in 2 cases. Sensory recovered to S4 in 1 case, S3 in 3 cases and S2 in 1 case. Evaluation of the appearance satisfaction of patients was 5 points in 3 cases and 4 points in 2 cases.
Conclusions
The radial collateral artery chimeric perforator flap combining a vascularized fragment of the distal humerus, which can reconstruct skin soft tissue and bone simultaneously, has good postoperative feeling and function recovery, and satisfactory appearance, and is an effective method to repair the defect of thumb complex tissue.