上肢屈曲性旋转撕脱离断伤的形成及功能挽救

目的探讨上肢轴向屈曲性旋转撕脱离断伤的形成以及侧胸和背部组织在功能挽救中的应用方式和疗效。方法2000年7月～2003年9月共收治6例上肢轴向屈曲性旋转撕脱离断伤患者,所有病例行一期再植或寄养再植。术后肩关节外展90°、肘关节屈曲100°位石膏或支具固定,6周后去除固定行功能锻炼。结果6例患者再植均顺利成活,随访3个月～2年,术后肩关节外展50°～90°,前屈50°～70°,后伸20°～30°,内收20°～40°;肘关节屈曲100°～140°,伸-20°～0°;重建术后3个月时屈肘肌力达Ⅳ～Ⅴ级。结论充分利用侧胸和背部组织特点进行分期、分层手术,解决创面覆盖和功能重建互相干扰的矛盾,是挽救严重轴向屈曲性旋转撕脱离断伤上肢,恢复其外形和功能的可靠方法。     

带蒂联合皮瓣移植修复上肢广泛软组织缺损

目的 探讨上肢广泛软组织缺损皮瓣修复方法的选择.方法 12例肘部、前臂及腕掌部高压电烧伤、热压伤及碾压伤患者,清创后4例应用背阔肌肌皮瓣与髂腰部皮瓣联合修复,将背阔肌肌皮瓣部分形成岛状,胸背血管蒂通过腋窝,上臂内侧皮下,髂腰部皮瓣部分以旋髂浅血管为蒂,皮瓣的蒂部形成皮管,位于腹股沟处,3周后再行断蒂;2例背阔肌肌皮瓣与侧胸皮瓣联合,将胸背动静脉游离出置于侧胸皮瓣内后形成皮管.蒂部位于侧胸上部;6例以巨大胸腹部联合皮瓣带蒂转移修复,以脐旁血管及肋间血管外侧皮支为轴,形成巨大皮瓣包绕前臂环形创面.结果 1例皮瓣远端局限坏死2 cm及皮瓣下感染,余全部成活,效果满意.结论 上肢创伤广泛软组织缺损,早期清创,应用带蒂联合皮瓣、肌皮瓣修复是一种简单、安全、可靠的方法.     

应用胫前肌瓣修复胫骨骨髓炎合并软组织缺损

自1999年1月-2005年3月,应用胫前肌瓣修复胫骨骨髓炎合并软组织缺损13例,同时辅以中药治疗,获得较满意的效果,现报告如下。1临床资料本组13例,男9例,女4例;年龄18~67岁,平均32岁。致伤原因:车祸伤6例,挤压伤4例,烧伤1例,坠落伤2例。胫骨上1/3段1例,中1/3段2例,下1/3段5例,中下2     

Reconstruction of plantar defects

Plantar defects are a challenge for the plastic surgeon; from 1984–1995 59 operations were performed in 57 patients. The radial forearm flap and the latissimus dorsi (LD) flaps were mainly used depending on the amount of tissue loss. Local flaps such as dorsalis pedis and instep flaps were used for smaller defects. The radial forearm flap is ideal in terms of thickness and stability for the sole but limited in its size. The LD flap is a safe procedure especially for severe injuries and osteitis, but has the disadvantage of being bulky and debulking procedures are frequently performed. For nerve reconstruction deep sensibility seems to be sufficient in order to obtain stable postoperative results. In this report the different operative methods are evaluated. Since 1991, the patients were monitored with static and dynamic foot pressure measurements and gait analysis to assess the postoperative result and prevent pressure ulcers, scar irritation and hyperkeratosis. Preoperative investigations may contribute to an optimal schedule for planning and stabilization of the operative regimen.     

隐动脉筋膜蒂的交腿皮瓣修复小腿严重软组织缺损

目的探讨一种小腿严重软组织缺损的修复方法。方法以健侧隐动脉为蒂的顺行或逆行交腿皮瓣修复患侧小腿软组织缺损。结果本组8例均有效地覆盖受区创面,随访三个月,皮瓣全部成活。结论该皮瓣不牺牲小腿的重要血管,质地与受区相似,方法简单易行,血运可靠,血管蒂长,是修复小腿严重软组织缺损的较好方法。     

Deep benign fibrous histiocytoma of the knee: CT and MR features with pathologic correlation

Magnetic resonance imaging and pathologic findings in a 28-year-old patient with a giant deep benign fibrous histiocytoma in the popliteal fossa of the right knee are described. The MR imaging findings include a well-delineated oval mass with low signal intensity on T1-, and high signal intensity on T2-weighted, images, and marked peripheral contrast enhancement. To the best of our knowledge, this is the first report on the MR findings in this entity. Received 28 July 1997; Revision received 21 October 1997; Accepted 27 October 1997     

33 factorial design-based optimization of the formulation of nitrofurantoin microcapsules

A microcapsule form of nitrofurantoin was prepared by a simple coacervation method with carboxymethylcellulose and aluminium sulfate. 3³ factorial design was performed for three independent variables, namely, the particle size of the drug, the size of the microcapsules and the pH of the dissolution medium. The dissolution tests with the formulated microcapsules were carried out according to the United States Pharmacopeia XXII rotating basket method at pH 1.2, 5 and 7.5, which represent the pH of gastrointestinal fluids. Release data were examined kinetically and the ideal kinetic models were estimated and t _63.2 values obtained from RRSBW distribution were used in the factorial design experiment. The influence of the independent variables on the dissolution of nitrofurantoin microcapsules could be expressed as the pH of the dissolution medium > particle size of the microcapsule > particle size of nitrofurantoin. The other aim of this study was to evaluate microcapsule formulation in terms of the United States Pharmacopeia criteria with a minimum of experiments. Our findings suggest that dosage forms which comply with the pharmacopoeia criteria for dissolution can be prepared and selected by factorial design.     

Towards the phenotyping of soft tissue tumours by cell surface molecules

Summary This study is aimed at the characterization of soft tissue tumours (STT) by means of cell surface molecules. To achieve this, normal mesenchymal tissues were extensively examined for expression of leucocyte differentiation (CD) antigens and HLA molecules. The panel of antigens finally examined in STT comprised CD10, CD13, CD24, CD34, CD36, CD56, CD57, HLA-A,B,C, ₂-microglobulin, HLA-DR, -DP, and -DQ and the HLA-D-associated invariant chain (Ii). STT were determined by conventional histomorphological and immunohistochemical criteria. The immunohistological analysis was based on serial frozen sections, one of which was used to demonstrate CD53 antigen. This very broadly distributed leuco/histiocyte-restricted antigen allowed for the distinction between the background of interstitial stromal cells and the neoplastic population. In some STT, the expression pattern of the cell surface molecules corresponded to that in their non-neoplastic counterparts. The majority of STT, however, showed considerable changes in the cell surface immunophenotype compared to their cells of origin. These alterations consisted mainly in an aberrant induction/neoexpression and, to a much lesser extent, in an aberrant down-regulation/loss of cell surface antigens. Nevertheless, some immunophenotype configurations are described which, for the time being, can be considered to be useful supplements in the differential diagnosis of this complex class of tumours. The data also indicate considerable changes in cell surface antigen expression occurring in the course of neoplastic transformation of mesenchymal cells. Detailed analysis of alterations in the functional repertoire of neoplastic mesenchymal cells might provide new insights into the biology of STT, possibly leading to new concepts for therapeutic intervention.This study was supported by the Tumorzentrum Heidelberg/ Mannheim and by the Dr. Mildred-Scheel-Stiftung für Krebshilfe (W50/89/Mö2)     

Histopathological grading of soft tissue tumours. Prognostic significance in a prospective study of 278 consecutive cases

A consecutive 10-year series of 278 soft tissue sarcomas was prospectively graded, using a system based on the number of mitoses and taking into account parameters such as cellularity, anaplasia, necrosis, and histogenetic type and subtype of tumour. Prognostic factors in relation to metastasis-free survival were studied by uni- and multivariate analysis. Fifty-seven (20.5 per cent) were low-grade tumours, 43 (15.5 per cent) were intermediate, and 178 (64 per cent) were high grade. High-grade tumours were divided into two groups; 80 (29 per cent) grade 3A (= 5-20 mitoses per 10 high power fields (HPF)) and 78 grade 3B (28 per cent) (= more than 20 mitoses/10 HPF); 10 HPF corresponds to 2.5 mm2. Twenty (7.2 per cent) high-grade tumours could not be further subdivided. Grading was found to be the prognostic factor associated with the strongest predictive value. Five-year survival in low-grade and intermediate tumours (95 and 86 percent, respectively) differed significantly (P less than 0.0001) from high grade (50 per cent) and (p = 0.0018) between grade 3A (64 per cent) and grade 3B (41 per cent). Other prognostic indicators of importance in high-grade tumours were age, local recurrence at presentation (primary operation outside the Centre), and localization (superficial vs. deep).     

Testing device to determine the dynamic rheological properties of soft tissues in biaxial elongation

A testing device has been developed which simultaneously measures,in vitro, the anisotropic dynamic viscoelastic moduli of bidimensional biological membranes such as the vascular wall, mesentery or skin. These measurements can be carried out as a function of the frequencies (0·5 Hz to 15 Hz) and the initial bidimensional strains (in a range of extension ratios λ_x and λ_y varying from 1·005 to 2·3 for a 3×3 cm specimen). The amplitude of the periodical deformations in both directions amounts to 0·25 percent of the undeformed dimensions.