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Experimental study on the treatment efficacy of femoral-head osteonecrosis by umbrella strut bone grafting and bone marrow mesenchymal stem cells

Yawei CAO ; Yisheng WANG ; Feng HAN ; Zilong SHEN

Chinese Journal of Microsurgery.2010;33(4):293-296,后插四. doi:10.3760/cma.j.issn.1001-2036.2010.04.012

Objective To discuss the treatment efficacy of the femoral-head osteonecrosis by umbrella strut bone grafting and bone marrow mesenchymal stem cells. Methods The femoral-head osteonecrosis models on one side were established in forty-two goats using liquid nitrogen, which were randomly classified into three groups after 8 weeks. Group A were conducted umbrella strut bone grafting and bone marrow mesenchymal stem cells transplantation, group B were conducted simple unit side muscle bone flap grafting, and group C were conducted umbrella strut bone grafting and Cancellous bone grafting transplantation. The health side of three groups was treated as self-control. The radiological and histology examination were made at 3,6treated lateral femoral-head shape restored,cystic cnlow-density area disappeared, the original collapse had repaired, and no further collapse of the femoral-head shaped for both group A and B. Bone fusion was good and bone column shadow had been vague for group A, while the bone fusion healed somewhat less and bone column shadow still clear for group B. Group C had irregular contour of femoral head, flat collapse, uneven density, and fracture cracks could be seen at weight-bearing area of femoral head, obviously was the poorest bone had different states: mature and arranged ruled for group A, childish and irregular arrangement for group B, thinning, sparse and fracture for group C. The percentage of empty lacunae counts decreased, while the percentage of trabecular bone area fraction increased for group A. In contrast with group B, and C, the difference was statistically significant (P ＜ 0.05), but the difference was no longer statistically significant when contrast with healthy sides (P ＞ 0.05). 6 months later, the radiological and histology examination showed that:group A and group B had been no significant difference comparing to normal femoral heads, while the femoral head of group C collapsed and disappeared completely. Group A and group B were no difference comparing the healthy side (P ＞ 0.05)in the area fraction of trabecualr bone and percentage of empty lacunae counts, neither it was between group A and group B(P ＞ 0. 05). Conclusion The treatment efficacy of the femoral-head osteonecrosis by umbrella strut bone grafting and bone marrow mesenchymal stem cells was good and was better than cancellous bone grafting transplantation and simple unit side muscle bone flap grafting.

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Treatment of kid foot soft tissue defect with reverse flap with cutaneous branch of fibular artery combine with sural nerve nutritional vessel axial

Weiguang YU ; Xinzhong SHAO ; Li LV ; Xiaoqing SU ; Shuo SHI

Chinese Journal of Microsurgery.2010;33(1):12-14,91. doi:10.3760/cma.j.issn.1001-2036.2010.01.006

Objective To investigate the clinical efficiency of kid foot soft tissue defect with reverse flap with cutaneous branch of fibular artery combine with sural nerve nutritional vessel axial. Methods From Feb. 2006 to Feb. 2009, according to the position and size of the soft tissue defects, the sural nerve nutritional vessel flap combine with the cutaneous branch of the peroneal artery were desingned and obtained to repair the 5 cases soft tissue defects of the foot. The flap size ranged from 8 cm × 7 cm to 18 cm × 10 cm. The vessel pedicle of cutaneous branches ranged from 1.7 cm to 3.0 cm. The distribution of the vessel pedicle of cutaneous branches ranged from 4.5 cm to 8.0 cm on the lateral malleolus. Results All flaps survived completely in 6 cases. The outline and function were satisfactory during 6-18 months follow-up. Among of 6 cases, the sural nerve were anastomosed with the acceptor sensory nerve in all cases. The skin sense were sat-isfactory after 1 year of operation and 2-point discrimination was 10-13 mm. Conclusion The blood supply of this flap is reliable without sacrifice of major arteries. Flap elevation is easy. It can reverse to a long dis-tance and can repair large skin defects. Especially this flap could have some sensory nerve. It is very useful in repairing kid foot large soft tissue defect.

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Relationship and flap design on the perforators of the posterior leg

Xiangdang XU ; Kaiyu DAI ; Peng ZHOU ; Xindong YANG ; Maolin TANG

Chinese Journal of Microsurgery.2009;32(3):190-192,illust 3. doi:10.3760/cma.j.issn.1001-2036.2009.03.008

Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.

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Applied anatomy for the transposition of the periosteal flap pedicled with the lateral anterior malleolus vessel on the anterior external of tibia distally based

Fahui ZHANG ; Zhenguang CHEN ; Heping ZHENG ; Yun XIE

Chinese Journal of Microsurgery.1998;0(01):-.

Objective To provide anatomical basis for transposition for the periosteal flap pedicled with the lateral anterior malleolus vessel on the anterior external of tibia distally based. Methods The origins, course, branches distribution, and anastomosis of lateral anterior malleous artery and periosteal vessels of the anterior external of tibia distally based were observed on 30 adult cadaveric feet. Results Lateral anterior malleolus arteies had 1～2 branches, whose diameters were(1.6?0.4)mm and the distances the above cusp of extrnal malleolys cusp were(1.1?0.4)cm, the arteries sent off the 1～3 pieces periosteum branches with diameter 0.4 to 0.8 mm, which distribute to the periostalr of anterior external of tibia distally based. To circulate anterior external of lateral malleouls of perforating descending branch of peroneal artery [the distances the above cusp of external malleolys cusp were (5.6?0.5)cm],the arteries sent off the 2～6 pieces periosteum branches with diameter 0.5 to 1.0 mm, which distributed to the periostealr of anterior external of tibia distally based and lateral malleolus. Both anastomosis site in the above cusp of external malleolys cusp were(1.7?0.6)cm, the distances the point of lateral anterior malleolus artery were(2.5?0.6)cm. The artery of anastomosis to undergo posterior of extensor digitorum brevis, along anterior border of tendon of short peroneal muscle, anastomosed with the lateral tarsal artery and the medial taesal atery. Conclusion It is an easy practical for repairing fracture of neck of talus fracture and ischemic necrosis of talus body to achieve the transposition of periosteal flap pedicled with the lateral anterior malleous vessel on the anterior external of tibia distally based.

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An experiment of repairing long and thick and burnden bone defects by two fibula compound transplantation under periosteum with vascular loop

Qishen FAN ; Kaigang ZHANG ; Kai ZHANG ; Xiangji ZHOU

Chinese Journal of Microsurgery.1998;0(01):-.

Objective To study the effect of operation on transplanted fibula healing,which repaired long and thick and burnden bone defects by two fibula compound transplanation under periosteum with vascular loop. Methods Seventy-two healthy rabbits were divided randomly into three groups.Group A is the mono-fibular transplanation group;group B,the double fibular transplanation extra-periosteum and group C,the double fibular transplanation under-periosteum.Each group consisted of 24 rabbits.Animal models of 10mm tibial defects were established and three operation patterns were performed.the serum were obtained to determine the level of ALP and BGP bone and mineral density and biomechanic index at 2,4,8,12,16 weeks.4 rabbits of each group were examined roentgenographically and histologically.the condition of the bone healing and contour were observed.The different effects of each operation were compared with such observation index. Results The X-ray showed that the area of the external callus were larger in C groups than that in A,B and eht bone trabecula were in order,the fibula showed significant bone hypertrophy.the serum ALP,BGP and mineral density level were higher in C group than that in A,B.the difference has statistical significance (P

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Microsurgical management of premalignant and malignant lesions of the conjunctiva

Huasheng YANG ; Zhongyao WU ; Siming AI ; Yuxiang MA ; Zhicong CHEN

Chinese Journal of Microsurgery.1998;0(01):-.

Objective To evaluate the methods and efficacy of microsurgical treatment for the premalignant and malignant lesions of the conjunctiva. Methods Forty-seven patients witn premalignant and malignant lesions of the conjuncitva were managed by microsurgical, these patients include 12 melanoma, 26 squamous cell carcinoma, 6 Bowen’ diseases, 3 primary acquired melanosis. The surgical method differs with limbal tumors, extralimbal tumors, and primary acquired melanosis. Results In all 47 patients, the tumor was completely removed in in one procedure. After follow-up for 4~60 months(mean 17 months), these were no tumor recurrence. Conclusion It is effective methods that premalignant and malignant lesions of the conjunctiva are managed by microsurgical resection, alcohol application, and supplemental cryotherapy. Careful propeirativa clinical evaluation of patient with a conjunctiva neoplasm is important in making the correct diagnosis and planning the surgical approach.

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An experimental study on revascularization after vascularized bone allograft

Shengxiang TAO ; Zhenguang CHEN ; Yun XIE ; Xiaohui ZHENG ; Yuhua YANG

Chinese Journal of Microsurgery.2008;31(2):119-121,illust 7.

Objectives To explore the process and regularity of graft after vascularized bone allograft. Methods An adult rabbit model of massive femoral defect was established and reconstmcted with vascularized bone allograft based by laterial rotating femoral vessel.The experiments were carried out in two groups,the experimental group(vascularized bone allograft)and the control group(nonvascularized bone allograft).Then observation on periosteum,cortex and marrow was performed after operation containing in ink-infused specimen. Results The revascularization in the experimental grouD was observed synchronicly on periosteum,cortex and marrow after operation,while the phenomenon of vascularization took place from periosteum to marrow in the control group.The density of micro-vessel in experimental group were 10.0±1.8,15.8±1.5 and 13.8±1.5,13.8±1.5 respectivly after 2,4,8 and 16 weeks.and those were 2.8±0.8,6.0±0.9,5.5±1.0,6.0±1.1 in control group.The ink-infused experiment demonstrated a better revascularization in the experimental group. Conclusion The vaseularization can promote revascularization of graft during bone allograft.

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Facial and frontal reconstruction with a modified radial artery perforator-based flap

Qingping XIE ; Enqi GUO ; Peihong JIN ; Xinwei XU ; Ben FAN ; Liang WANG

Chinese Journal of Microsurgery.2010;33(1):6-8,89. doi:10.3760/cma.j.issn.1001-2036.2010.01.003

Objective In attempt to improve the reconstruction of small defects in the facial and frontal regions, we developed a modified radial artery perforator-based free flap. Methods The free proxi-mal radial forearm flap was based on the distal perforator of the radial artery and the concomitant radial vein. The vascular pedicle passed through deep fascia. The free flap was transferred to repair the defects of the fa-cial and frontal regions. Results In 6 patients with frontal defects and 4 patients with facial defects, all flaps survived completely. After following up for 6-12 months, flaps underwent plastic surgery to become thin-ner. The flaps of 10 cases were good in skin texture and color at recipient sites. The scars were cosmetically acceptable. The superficial sensibility recovered well. Conclusion A modified radial artery perforator-based free flap was useful in coveting small defects of the facial and frontal regions.

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Experiment research of the function of human umbilical cord blood mesenchymal stem cells in the regeneration of rat's sciatic nerve

Zhongren WANG ; Bo YANG ; Limin WANG ; En LI

Chinese Journal of Microsurgery.2009;32(5):387-389,illust 6. doi:10.3760/cma.j.issn.1001-2036.2009.05.015

Objective To evaluate the efectiveness of using mesenchymal stem cells(MSCs)derived from HUCB(human umbilical cord blood)to a tissue engineered bioartificial nerve on bridging a 1 0 mm sciatic nerve gap.Methods The cord blood mononuclear cells were isolated by lymphocyte separation medium,purified and expanded with MesencultTM medium and acidic environment to produce adherent layer(MSCs).Thirty SD female rats were randomly divided into three groups.Group A:Human amnion tubes were seeded by HUCBMSCs together with fibrin sealant.Group B:Human amnion tubes were seeded only with fibrin sealant.group C:autografts.9 weeks later,a series of examinations were performed which included morphological,sciatic nerve function index,weight of gastrocnemius,histological staining and immunostaining of S100.Results The HUCB-derived mononuclear cells,when seeded in specific medium,gave rise to adherent cells (MSCs).At 9 weeks after the operations,all the examinations of group A was better than group B(P＜0.05).Conclusion HUCBMSCs can be isolated,purified, cultivated and expanded Mesencult~(TM) medium.HUCBMSCs can promote the nerve to regenerate in reparing the sciatic nerve gap.

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The amplifying results of repairing degenerated receptor nerves with normal donor nerves

Yuhui KOU ; Xiaofeng YIN ; Baoguo JIANG ; Yanhua WANG ; Peixun ZHANG ; Hongbo ZHANG

Chinese Journal of Microsurgery.2008;31(5):354-357,405.

Objective To investigate the amplifying results of repairing degenerated distal receptor nerves with normal proximal donor nerves.Methods The study was carried out on 12 adult male SD rats that randomly derided into degeneration group and control group.The distal tibial nerve stumps as receptor nerve were denervated for 8 weeks before cross-sutured with partial freshly transected proximal common peroneal nerve stumps in the degeneration group,while in the control group,freshly transected distal tibial nerve stumps were sutured with partial freshly cut proximal common peroneal nerve stumps.The motor nerve conduction (MCV),muscle rigidity contraction force were measured,the histological examinations were carried out and the numbers of myelinated axons were calculated 3 months after the operation.Results The degeneration group showed a poorer regeneration capacity than the control group (P＜0.05).The MCV were (16.992 ± 3.737) m/s,(23.092 ± 2.788) m/s respectively;The ratio of muscle force were (39.642 ±5.865)% and (71.098± 6.778)% respectively.The regenerated myelinated nerve fiber number were 1718.2± 282.0 and 3340.0 ± 506.5 respectively in degeneration group and control group.The amplifying ratio of the degeneration group and control group were 1.581 ± 0.329 and 3.098 ± 0.642.Conclusion The amplifying results of repairing the degenerated nerves are poorer than repairing the freshly injury distal nerves with the freshly transected proximal donor nerves,the results demonstrate a progressive inability of chronically degeneration of the distal nerve to support axonai regeneration.

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