Experimental study on early repair of oromaxillofacial perforating soft tissue defect due to gunshot in dogs

The left cheek of 8 adult male mongrel dogs was shot with M1935.56mm bul-let fired through an US-made M16 rifle to result in a perforating soft tissue defect.Pri-mary debridement was performed immediately and the secondary debridement 72h alter in-jury.After the secondary thorough debridement,the cutaneous side of the defect was re-paired with a saphenous artery-vein free skin(muscular)flap using microvascularanastomosis,and the oral side of the defect was repaired by drawing the surroundingmucosa together and fixing with sutures or with a local sliding mucous membrane flap.All the animals were kept under observation for 2～6 months.It was believed that the pri-mary debridement and secondary thorough debridement were both essential. The survivalrate of the free tissue flap was 75%(6/8).These facts suggest that early repair ofthe oromaxillofacial perforating soft tissue defect due to gunshot is practicable.     

Effect of three interventional bronchoscopic methods on tracheal stenosis and the formation of granulation tissues in dogs

Background Therapeutic approaches for tracheal stenosis caused by the formation of exuberant granulation tissues usually include electrocautery, mechanical dilation, laser therapy, argon plasma coagulation （APC）, cryotherapy and stent placement. However, restenosis after stent insertion remains a significant limitation. We examined the efficacy of three different approaches, including induction of mechanical lesions, APC performed with different powers or durations and cryotherapy, to identify the method that limited the formation of granulation tissue. Methods Twelve specially bred research mongrel dogs were divided into three groups. In group 1 （four dogs） mild （procedure 1; two dogs） or moderate （procedure 2; two dogs） damage was induced mechanically. Group 2 （six dogs） received APC at different powers or durations （procedure 3：30 W, 1 cm/s; procedure 4：30 W, 2 cm/s; procedure 5：25 W, 3 cm/s）. Group 3 （two dogs） received cryotherapy （procedure 6： two freeze-thaw cycles of 30 seconds）. Uncovered self-expandable metallic stents were inserted in all dogs to maintain a continuous stimulus to the trachea mucosa. Dogs were monitored for 4 weeks and the relationship between granulation tissue proliferation and method used was analyzed. Results In group 1, granulation tissue growth increased with more severe mechanical damage. The growth of granulation tissue in group 2 was more pronounced than in group 1, and both dogs in procedure 3 died because of severe stenosis. In this group, the formation of granulation tissue decreased with decreasing power and duration. In group 3, no obvious granulation tissue was found at week 4. Conclusions Lesions and stimuli from a foreign body （the stent） are two important factors that lead to overgrowth of granulation tissue. Thermal lesions, such as APC, seem to induce greater granulation tissue growth and cartilage damage compared with mechanical and cryotherapy lesions. Cryotherapy in combination with mechanical dilation may be a safe and effective treatment method for managing tracheal stenosis caused by the formation of granulation tissue.     

Reconstruction of soft tissue defect of the extremity with the perforator flap from inguinal region

Background The perforator flap has become a very useful reconstructive means of soft tissue defect of extremities. The perforator flap from the inguinal region has advantages that include the ability to cover a large area with little donor site morbidity and provision of suitable thickness for reconstruction. Methods From July 1, 2005 to June 30, 2007, 10 patients with various types of soft tissue defect underwent reconstruction with 10 perforator flaps from the inguinal region. Six flaps were applied to the upper extremities and four flaps to the lower extremities. The dimensions of the transferred flaps ranged from 7-30 cm in length and 4-10 cm in width. Results The postoperative course of all 10 flaps was uneventful and all flaps survived. Distal small partial necrosis was observed in one case due to arterial insufficiency of the distal part of the flap. All patients were satisfied with the functional and esthetic resurfacing outcome. Conclusion Use of perforator flap from the inguinal region could overcome the disadvantages of the traditional free groin flap, and represents a safe and useful tool for coverage of soft tissue defects.     

Bridging bronchus complicated with a left pulmonary artery sling a rare entity

To the editor： The bridging bronchus （BB） is a rarely reported congenital anomaly in which right middle and lower lobes are supplied by an accessory bronchus arising from the left main bronchus,1 A sling left pulmonary artery （SLPA） is also a rare congenital cardiac malformation, in which the left pulmonary artery arises from the right pulmonary artery and passes between the trachea and esophagus, causing tracheal stenosis by the pulsating pulmonary artery.： Here we present a rare pediatric case of BB complicated with a SLPA.     

Artificial trachea reconstruction with two-stage approach using memory-alloy mesh

Artificial tracheal prosthesis is now a challenge to the entire surgical field all over the world. Previously, all kinds of prosthesis were "inner stent" that could not be integrated with native trachea. Since there is an interface between smooth surface of the prosthesis and living tissues, and the inner side of the prosthesis is not covered with living membrane, infections always happen around the prosthesis. We then developed a new technique, which combined memory-alloy mesh with traditional operative procedures. Memory-alloy mesh is extensible, flexible and can maintain the shape of a tube. It has very good compatibility with tissues and no antigenicity. Thus, it is the most desirable material nowadays that can be found to make the frame of an artificial trachea by using a two-stage approach. That is imbedding a pre-shaped memory-alloy mesh under skin or endothelium (pleura or peritoneum), and then making the "sandwich" pedicle skin and muscle flap to a pedicled artificial trachea anastomosed with native trachea. After a two-year experimental study, a patient received the artificial trachea replacement on April 18, 2002, with a good result.     

Experimental replacement of thoracic esophageal segment with a biomaterial artificial esophagus in dogs

Objective：To implant 80 mm-long artificial esophagi constructed of biomaterial in dogs, observe the perioperative survival rates and the incidence of postoperative complications, and study the mechanisms of postoperative healing. Methods： Specimens of the implanted esophagus, the ＂neo-esophagi＂, were taken for histopathologic study 1, 3, 6, 12, 24 months after operation. Results： The incidence of anastomotic leakage after the artificial esophagus implantation was 3.33%. The perioperative survival rate was 96.67%. The incidence of postoperative stenosis in the ＂neo-esophagi＂ was 81.48%; the stenoses were treated by expanding with esophagoscopy and implanting a stent. Epithelization of the mucosa in the ＂neo-esophagi＂ was completed in 3 to 6 months after surgery Structures such as submucosal muscle layers, mucous glands, nerve fibers, capillaries, etc. were regenerated after 12 months, and then reconstruction of the fibrous connective tissue layer was completed. Conclusion： Implanting a biomaterial artificial esophagus accomplishes safe reconstruction of defects in the esophagus. Advanced cellular structure of ＂neo-esophagus＂ can be regenerated after 1 year. Postoperative stenosis, which is related to hyperplasia and retraction of scar tissue, is still the most common complications which limiting the clinical application of the artificial esophagus.     

Treatment of medium and late stage esophageal carcinoma with combined endoscop ic metal stenting and radiotherapy

Objective To evaluate clinical feasibility and efficacy of endoscopic metal stenting combined with radiotherapy for treatment of medium and late stages of esophageal carcinoma.Methods Thirty-four patients of late stage esophageal carcinoma were treated with endoscopic stent implantation in combination with radiotherapy.Evaluations of CES stainless steel metal stent on the effect of radiation,clinical symptom alleviation and complication and survival rates in both groups were made.Results ①CES stainless steel metal stent had no effect on radiation dosage distribution.②Dysphagia was markedly alleviated in both groups and different complication rates were observed between the two groups.③Six,nine and twelve month survival rates of inpatlents treated with comblned therapies were significantly higher than in simple stent implantation patlents.Conclusion Endoscopic metal stenting in combination with radotherapy was a feasible and practical management in treating medium and late stages esophageal carcinoma and was superior to simple metal stent implantation.     

Applied distally based peroneus brevis muscle flaps for coverage of the soft tissue defects over the lower one-third of the leg, ankle and foot

Objective To investigate a simple, valuable new method for coverage of the soft tissue defect over the lower one-third of the leg, ankle and the foot. Methods The distally based peroneus brevis muscle fkps were applied for coverage of the soft tissue defects over the lower one-third of the leg,the ankle and the foot. The muscle flaps were covered with split-thickness skin grafts. Results The distally based peroneus brevis muscle flaps were applied for coverage of the soft tissue defects over the lower one-third of the leg, the ankle and the foot in 16 cases. The larges area of the soft tissue defect was 5 cm × 7 cm. The smallest was 3 cm × 4 cm. Primary healing occured in 14 cases undergoing muscle flap construction, second-stage healing occured in 2 cases, no total flap necrosis occured in any cases. Conclusion ThisChina Medical Abstracts(Surgery) technigue is a simple and complication are lesser. The successful rates are higher. This muscle flap is suitable to the mudium or small soft tissue defect     

Laryngotracheal flap for reconstruction of hypopharynx and upper esophagus after resection of advanced pyriform sinus cancer.

Reconstruction of the hypopharynx and upper esophagus after resection of advanced pyriform sinus cancer, is usually complicated and time-consuming. Laryngotracheal flap was used in hypopharyngoesophageal reconstruction for 26 elderly patients with advanced pyriform sinus cancer Pharyn-gocutaneous fistula developed in 5 patients and healed spontaneously without further surgery. Full diet was resumed in all the patients. The surgical technique and its advantages and disadvantages are discussed. The laryngotracheal flap in the reconstruction of hypopharyngoesophageal defect for elderly patients is a procedure of choice.     

Application of free vein skin flap on the anterior aspect of wrist in the case of finger injury with vessel and skin defect

Objective To introduce an effective reconstruction method for the finger injured with vessel and skin defect. Methods Free skin flap with skin vein was transplanted on the site of tissue defect, connecting by anastomosis the vein with artery or vein of the finger. Results Seven cases were treated with this method,among which 5 cases have sikin defect on the palm aspect of fingers, the rest have skin defect on the dorsal aspect skin of finger. All fingers survived with good shape and function. Conclusion This is a simple and effective method of finger reconstruction for the patients with defect of vessels and skin. 6 refs.     

肺组织修补胸内气管规则缺损的新术式研究

目的：探索应用自体带血运的肺组织瓣修补胸内气管不规则缺损的手术新方法，为临床应用提供动物实验依据。方法：将12例实验犬的气管进行不同侧面的不规则切除。缺损区域置入网架支撑，缺损面用自体带血运的肺组织瓣覆盖，缝闭。结果：2例实验犬术后1周内死亡，不同时段处死8例，2例仍存活者，最长达53周。病理显示吻合愈合良好，有新生粘膜上皮爬行。结论：应用自体带血运的肺组织瓣修补胸内气管不规则缺损是气管外科的一种创新术式，肺组织瓣取材方便，便于操作，可以作为胸内气管缺损的修补材料。     

食管缺损经肺组织瓣和金属支架重建后黏膜爬行的光镜和电镜观察

 目的 探讨肺组织瓣修复食管侧壁缺损内衬金属支架的方法进行食管重建的可行性。 方法 选取成年犬12条,切除中段食管,选用右中叶肺组织作为替代物,将金属支架放置于缺损处食管内,用游离的肺组织瓣修补食管缺损。术后行钡餐透视检查及病理学检查,通过光镜和电镜观察黏膜的爬行过程,爬行的新生上皮的超微结构。结果 新生食管复层上皮与肺组织瓣连接紧密,愈合良好。但术后18周腺体和平滑肌的再生均不明显。结论 肺组织瓣内衬金属支架重建食管为食管替代提供了一种新的尝试，作为支撑物其远期效果有待进一步探讨。     

金属网架外覆肺组织替代气管的动物实验研究

目的：寻求气管重建的新方法,解决较为复杂的长段气管重建问题。方法：选用杂种成年犬12只,将一叶肺组织脏层胸膜向内翻转缝合成管状内衬记忆合金网架与切除后的气管远近端行端端吻合,完成气管重建。结果：8只实验犬获得存活,病理证实吻合口愈合良好,术后两周替代物管腔内即有新生上皮爬行,结论：该实验提出了带血运的肺组织内衬记忆合金网架替代气管这下 新方法。为长段气管缺损修补、重建提供一个有效的新途径。     

带蒂颈阔肌肌皮瓣与镍钛合金网结合再造颈段气管实验研究

目的：探讨用带蒂颈阔肌肌皮与镍钛合金网结合再造颈段气管。方法 选健康狗20只,0袖状切除8－10个气管环长度的颈段气管,用带蒂颈阔肌肌皮瓣卷成肌皮管,表皮衬里,腔内交管临床扩张,将肌皮管移于气管缺损处,与气管切端吻合,再用相应长度镍钛合金网状支架套于肌皮管外,并固定。术后4－6月经气管镜拔出硅胶管。结果 2只动物术后切口感染而终止实验。余动物均健康存活,呼吸、发音、及远动正常。CT检查示新气管管腔宽敞,无狭窄现象。术后6－18月分期处死动物,见植入物与气管连为一体,镍钛支架与肌皮管及周围组织粘连紧密,不易分离。管壁皮肢的鳞状上皮逐渐变薄,并最终化生为单层矮柱状上皮细胞。镍钛合金光洁如初。结论：带蒂颈阔肌肌皮瓣与镍钛合金风结合组成的“新气管”可适用于颈部气管的重建。     

肺组织瓣修补胸内食管不规则缺损的新术式研究

目的:探讨自体带血运的肺组织瓣修补胸内食管不规则缺损的手术新方法,为临床应用提供动物实验依据.方法:将14只实验犬的胸内食管行不同侧面的不规则切除,缺损面用自体带血运的肺组织瓣修补.观察其存活、进食情况以及愈合过程.结果:3只犬术后1周内死亡,11例存活,最长存活时间超过110周.存活犬食管缺损处的管腔表面可见新生的黏膜上皮爬覆.存活犬均能经口进食.结论:应用自体肺组织瓣修补胸内食管不规则缺损可作为一种简便易行的新术式.     

可降解复合人工食管重建犬颈段食管的实验研究

目的：研究聚氨酯胶原蛋白壳聚糖复合人工食管重建犬颈段食管的可行性。方法：将医用聚氨酯管表面覆盖海绵状胶原蛋白壳聚糖膜制成的人工食管，通过手术替换15只犬颈段5cm食管缺损，术后给予营养支持，禁食2周或4周后通过内镜取出聚氨酯内管进行观察。结果：禁食2周后取出聚氨酯内管的5只实验犬，新生食管上皮再生不完全，术后1个月内均出现进行性狭窄无法吞咽；禁食4周后取出聚氨酯内管的10只实验犬，术后1个月新生食管完全上皮化，术后3个月，黏膜全层结构完整再生，术后6个月食管肌层部分再生。结论：聚氨酯胶原蛋白壳聚糖复合人工食管重建犬颈段食管具有可行性，通过聚氨酯内管提供临时通道，海绵状胶原蛋白壳聚糖膜提供适宜细胞爬行再生的三维多孔支架并维持足够长的降解时间，能促使自身食管完全再生。     

人工食管脱落时间对猪新生食管通道功能形成的影响

目的 观察人工食管不同脱落时间对新生食管通道功能形成的影响,探讨人工食管替代切除食管术后安全脱落的时间范围及新生食管狭窄的处理方法 .方法 观察一组(18只实验猪)人工食管替代切除食管术后,第1、2、3、6个月不同时间段发生人工食管脱落所出现的并发症,新生食管的组织结构,进食功能以及实验动物的生存情况.结果 在1个月内发生人工食管脱落有3只,都发生新生食管严重狭窄(φ<0.5 cm)造成重度进食困难(Bown's Ⅳ级)并发症,食管扩张治疗失败,全部在短期内死亡.在2个月内发生脱管有4只,新生食管出现中至重度狭窄(φ 0.5～0.9 cm)导致进行性进食困难(Ⅲ～Ⅳ级),3只经反复食管扩张治疗效果不明显,短期内死亡,1只采用重置裸支架治疗能迅速解决进食问题,得以长期存活.在3个月内发生脱管有4只,新生食管出现轻至中度狭窄(φ0.9 cm～1.5 cm)导致轻至中度进食困难(Ⅰ级～Ⅱ级),除2只计划处死观察外,其余2只中度进食困难实验动物采用重置裸支架治疗迅速解决进食问题,长期存活.在3个月以后发生人工食管脱落有7只,新生食管呈现扩张并相对性狭窄(φ1.9 cm)和短暂的轻度进食困难(Ⅰ级),其后进食困难自行缓解,无须治疗均能长期生存.结论 人工食管(植入体)在原位停留时间2～3个月对形成一条具有通道功能的新生食管是必要的,停留时间越长,对形成具有通道功能的新生食管越有利,重置裸支架治疗对该时段脱管出现严重的新生食管狭窄有显著的治疗效果.超过3个月发生人工食管脱落,新生食管已形成具有通道功能的管道,对进食影响不大,实验动物都能长期生存.     

应用Sigma覆膜支架治疗食管气管瘘22例临床分析

目的 探讨Sigma覆膜支架治疗食管气管瘘的优点和使用方法.方法 对采用Sigma支架治疗的22例食管气管痿患者的临床资料进行分析.其中,食管癌17例,食管良性病5例,病史4 d～2个月.放置1个气管支架5例,气管食管双支架15例,3个支架2例;直管形气管支架18例,钝角L形气管支架3例,Y形气管支架1例.支架置入分为介入法和内镜法两种.结果 22例成功放置41个支架,无手术死亡.除了1例良性患者迁延不愈、1年后行手术治疗,1例气管支架封堵不完全,再次放置食管支架外,其余均一次治疗成功,2～4 d后可正常经口进食.成功率91%(20/22),未完全成功率9%(2/22).结论 食管和(或)气管放置Sigma支架可有效封堵食管气管瘘,患者术后均可正常进食.此支架优点是可以回收并能有效防止继发食管气管瘘.     

游离自体心包补片修复气管膜部缺损的实验研究

目的 研究游离自体心包补片修复气管膜部缺损的可行性.方法 选8条成年实验犬为研究对象.右后外侧切口进胸取实验犬心包壁作为补片移植物.暴露实验犬颈部气管,切除环状软骨下方第四气管环水平部分膜部形成约2 cm×2 cm大小全层缺损,并使用心包补片移植物修补受损气管膜部缺损.术后使用纤维支气管镜检查气管通畅度.实验犬存活至术后6个月实施安乐死,取气管标本计算收缩率,并进行组织学检查.结果 所有实验犬均未出现手术并发症,支气管镜检查未发现吸气或者呼气时气管塌陷.气管断面最狭窄部位与补片下第三软骨环部位之比平均为1.07±0.03.组织学检查显示所有补片移植物表面新生纤毛柱状上皮.结论 心包补片移植物修补气管膜部缺损安全且有效.     

16例气管插管并发气管食管瘘的临床护理

目的探讨气管插管并发气管食管瘘的临床护理方法与效果。方法选择因不同原因行气管切开套管置入留置过程中发生气管食管瘘的患者16例,观察护理方法与临床效果。结果气管食管瘘的平均发生时间为(46.5±18.6)d;采用带膜金属气管支架置入后的9例患者,呛咳及进食困难不再发生;另有4例空肠造瘘管饲和3例留置套管并且胃管鼻饲的患者其营养状态良好,水电解质保持平衡。结论气管切开套管置入留置时,应加强套管和球囊的护理以防气管食管瘘发生;气管食管瘘发生后,对应用带膜金属支架气管或食管置入,应掌握其专科配合和护理技术;对气管食管瘘保守治疗者,应熟练掌握管饲及其护理。