Shaped regeneration of rabbit ear perichondrium.

The neocartilage that regenerated from the ear perichondrium in 18 growing rabbits was shaped using biodegradable implants. The animals were divided into two groups according to the operation used. In group 1 a self-reinforced polyglycolic acid (SR-PGA) rod was placed inside a perichondrial pocket on the dorsum of the ear and surrounded by blood clot, and in group 2 a flap of ear perichondrium was shaped around an SR-PGA rod. Samples were taken for histological examination six weeks after the operation. Active growth of neocartilage was seen in both groups and the SR-PGA rod had successfully guided the perichondrial regeneration in most of the animals.     

Aesthetic aspects of reconstructive surgery of the lower lid

Aesthetic repair of the lower eyelid should use palpebral skin and restrict the cutaneous scars to the orbital area. Except in young patients or those having previously undergone a blepharoplasty, it is usually possible to raise a 10- or 12-mm-wide flap from the upper eyelid. The use of such a flap lined with an alar chondromucosal graft is advocated in a one-stage procedure. This graft ensures a good functional result and the stability of the new eyelid because the cartilage is as high in its bulk as the lid. In spite of histologic differences, where the tarsus is not a cartilage and the inner lining of the ala nasi is not actually a mucosa, the alar chondromucosal graft is very much like the tarsoconjunctival complex. When the alar defect is accurately repaired, no deformation of the nose results.     

颊部旋转皮瓣和软骨黏膜复合组织片修复全下睑全层缺损

目的 探索一种全下睑全层缺损Ⅰ期再造的手术方法.方法 对11例患者设计颊部旋转皮瓣再造下睑皮肤,鼻中隔软骨黏膜复合组织片游离移植再造下睑的结膜和睑板,完成Ⅰ期再造全下睑全层缺损.结果 11例再造下睑全部成活,除2例发生再造下睑轻度退缩外,无其他并发症发生,外形及功能均令人满意.结论 采用颊部旋转皮瓣覆盖皮肤,鼻中隔软骨黏膜复合组织移植片替代睑板和结膜行全下睑全层缺损再造,此术式操作简单,效果良好,是全下睑全层缺损再造的理想术式.     

颊部旋转皮瓣和软骨黏膜复合组织片修复全下睑全层缺损

目的 探索一种全下睑全层缺损Ⅰ期再造的手术方法.方法 对11例患者设计颊部旋转皮瓣再造下睑皮肤,鼻中隔软骨黏膜复合组织片游离移植再造下睑的结膜和睑板,完成Ⅰ期再造全下睑全层缺损.结果 11例再造下睑全部成活,除2例发生再造下睑轻度退缩外,无其他并发症发生,外形及功能均令人满意.结论 采用颊部旋转皮瓣覆盖皮肤,鼻中隔软骨黏膜复合组织移植片替代睑板和结膜行全下睑全层缺损再造,此术式操作简单,效果良好,是全下睑全层缺损再造的理想术式.     

应用口腔粘膜(或中厚皮片)尿道下裂修复术与感染的关系研究

目的:探索应用口腔粘膜(或中厚皮片)修复尿道下裂手术与感染的关系,研究采用这两种组织材料的三种再造尿道术式易感染性的差异,分析各术式与尿道下裂术后感染的关系,据此改进尿道下裂修复手术方法,降低感染率。方法:采用细菌培养鉴定法证实应用口腔粘膜(或中厚皮片)再造尿道的细菌的来源及种类。分别统计三种应用口腔粘膜(或中厚皮片)再造尿道手术方法的术后感染率,包括一期法口腔粘膜(或中厚皮片)与轴形皮瓣耦合再造尿道术、一期法口腔粘膜(或中厚皮片)与局部皮瓣耦合再造尿道术、分期法口腔粘膜(或中厚皮片)再造尿道术等三种术式。结果:三种方法的感染率均低于同时期尿道下裂术后平均感染率,三种术式中以分期手术感染率最低。结论:应用口腔粘膜(或中厚皮片)再造尿道,可以降低尿道下裂术后感染率。     

Myo-osseous intercostal pedicle flaps for tracheal reconstruction in puppies

We evaluated a myo-osseous intercostal pedicle flap for distal tracheal reconstruction. Mongrel puppies, 6 to 10 weeks old, underwent tracheal repair, 12 for primary defects and seven for stenotic lesions created in the distal trachea. A composite flap was constructed from the anterior portion of the fourth rib with the overlying pleura and periosteum and a posteriorly based intercostal muscle/neurovascular pedicle. The animals did well following tracheal reconstruction without evidence of airway obstruction. Bronchoscopy documented normal tracheal diameter and the repair site could not be discerned from the surrounding mucosa. Histologically, there was complete respiratory epithelial ingrowth with no inflammatory changes. The rib graft had active hematopoietic marrow. This work suggests that the myo-osseous intercostal pedicle flap provides a surface for normal epithelial ingrowth of tracheal mucosa without stimulating granulation tissue, interposes a stent capable of growth, therefore minimizing anastomotic stricture, and is an effective alternative in the management of distal tracheal stenosis.     

颊部旋转皮瓣和软骨黏膜复合组织片修复全下睑全层缺损

目的 探索一种全下睑全层缺损Ⅰ期再造的手术方法.方法 对11例患者设计颊部旋转皮瓣再造下睑皮肤,鼻中隔软骨黏膜复合组织片游离移植再造下睑的结膜和睑板,完成Ⅰ期再造全下睑全层缺损.结果 11例再造下睑全部成活,除2例发生再造下睑轻度退缩外,无其他并发症发生,外形及功能均令人满意.结论 采用颊部旋转皮瓣覆盖皮肤,鼻中隔软骨黏膜复合组织移植片替代睑板和结膜行全下睑全层缺损再造,此术式操作简单,效果良好,是全下睑全层缺损再造的理想术式.     

The folded, bipaddled pectoralis major composite flap in oral cancer reconstruction

We report on the pectoralis major composite (musculocutaneous or rib osteomusculocutaneous) flap used in bipaddled fashion for one-stage immediate reconstruction in 53 patients with oral cancer. Of these, 44 patients had lesions of buccal mucosa and lateral lower alveolus, and 9 patients had lesions of floor of mouth and middle third of lower alveolus. In one patient this flap was used as a free composite tissue transfer in bipaddled fashion. The flap can be used either before or after radiotherapy in oral cancer and provides both lining mucosa and skin cover. If necessary, a rib (vascularised bone graft) incorporated with this composite flap can give skeletal support for mandibular arch reconstruction.     

应用阴茎皮瓣结合颊黏膜游离移植治疗阴茎段尿道狭窄

目的总结应用阴茎皮瓣结合颊黏膜游离移植治疗阴茎段尿道狭窄的临床效果。方法2006年3月-2007年12月,收治6例尿道下裂修复术后阴茎段尿道狭窄患者。年龄3～26岁,均为阴茎型尿道下裂,于修复术后2～10个月出现排尿困难。采用阴茎皮肤脱套形成的阴茎皮瓣结合大小为2cm×1cm～4cm×1cm的自体全厚颊黏膜游离移植方法治疗,术后保留高弹硅胶尿道支架管2～3周。结果5例术后切口Ⅰ期愈合,无并发症发生,术后排尿满意;1例术后3d切口出现轻度感染,予冲洗引流等处理2周后愈合,术后1个月尿线变细,经约2个月尿道扩张后,正常排尿。患者均获随访,随访时间6～10个月。患者自述排尿正常,尿流成线,尿线较粗,排尿后膀胱无明显尿液残余。结论阴茎皮瓣结合颊黏膜游离移植是一期治疗阴茎段较短范围尿道狭窄的可行方法之一。     

Eyelid sebaceous carcinoma. A case report with literature review

Sebaceous carcinoma of the eyelids is a rare malignancy of which most cases require extensive excision followed by usually complete eyelid reconstruction. We report a case developed from the Meibomius glands of the lower eyelid. Complete excision was achieved by removing the entire eyelid 'en bloc'. Reconstruction was with a composite, chondromucosal septal graft layered on an upper eyelid, musculocutaneous, transposition flap based on a lateral pedicle. After a brief review of the relevant literature, the advantages and disadvantages of the various methods of complete lower eyelid reconstruction are discussed.     

Reconstruction of the total lower eyelid defect — useful modifications

Various techniques have been used for reconstruction of extensive lower eyelid defects, but it is difficult to achieve results which are satisfactory, both from a functional and cosmetic viewpoint. In the past three years, ten patients have been reconstructed using a cheek flap over a chondromucosal graft, after extensive resection of lower eyelid tumors. As a modification of the classic method, the dermal layer of the cheek flap was sutured to the inferior orbital rim to prevent late sagging and ectropion. In addition, a tie-over pressure dressing on the inner aspect of the lid was used to give good contact between the chondromucosal graft and the flap. At a one year follow-up, the results were judged to be good, both aesthetically and functionally.     

下睑部分全层缺损修复

１９９３年以来，共为４例下睑恶性肿瘤患者行扩大切除，术后下睑部分全层缺损的修复，采用鼻中隔粘膜软骨复合组织片及口腔粘膜游离移植的方法，以修复睑板睑结膜层，外层应用邻近带蒂旋转皮瓣覆盖，共同重建下睑。手术效果令人满意，成功的关键在于外层皮瓣的良好选择。     

Tracheal reconstruction with a prefabricated deltopectoral flap combined with costal cartilage graft and palatal mucosal graft

We have created an alternative method for tracheal reconstruction. Our new surgical procedure using a deltopectoral flap combined with a costal cartilage graft and mucosal graft for tracheal reconstruction allows us to achieve reconstruction of the tracheal mucosa, the tracheal cartilage, and the covering skin with adequate subcutaneous tissue. In one case, a tracheostenosis was reconstructed with a deltopectoral flap combined with a costal cartilage graft. In the other case, a tracheal defect was reconstructed with a deltopectoral flap combined with a costal cartilage graft and palatal mucosal graft. Although the operation is a multistage procedure, our method provides satisfactory clinical results. Thus, we believe that our method is useful for the surgical treatment of large tracheal defects.     

颊脂垫瓣在口腔缺损修复中的应用

目的评价颊脂垫瓣在修复口腔黏膜缺损中的应用。方法1998年5月~2004年7月,收治42例各种原因致口腔缺损患者,其中男26例,女16例,年龄25~76岁。颊部鳞癌7例,颊部白斑5例,软腭部鳞癌7例,腭部腺样囊性癌8例,上颌窦癌6例,上颌齿槽突血管瘤5例,上颌骨角化囊肿4例。病程2个月~10年。缺损部位颊部12例,上颌骨切除导致颊部上分缺损6例,口腔上颌窦瘘17例,软腭部缺损7例。缺损范围3.0cm×3.0cm~6.5cm×4.0cm。均采用颊脂垫瓣修复缺损部位,切取的颊脂垫瓣为颊脂垫的颊突及部分体部。结果术后41例颊脂垫瓣与创面期愈合;1例因缺损大,瓣成形后较薄而期愈合。术后4周水肿消退逐渐上皮化,6周完全上皮化,颊部外观无明显影响。35例获随访3个月~5年,颊脂垫瓣修复区与附近正常黏膜的层次和颜色、弹性、光滑度、质地无明显差异,咀嚼摩擦和食物刺激无明显影响。2例磨牙后区缺损者有轻度张口受限,经过开口训练恢复张口度。结论颊脂垫瓣能较快而有效地修复直径6.5cm以下的黏膜缺损,取材方便,术后无明显的供区并发症,是修复颊部、软腭和牙槽等部位黏膜缺损的理想组织。其缺点为修复范围较局限。     

The influence of human amniotic fluid on the potential of rabbit ear perichondrial flaps to form cartilage tissue.

Since several experimental and clinical studies demonstrated the chondrogenic potential of perichondrium, there has been great interest in examining factors that might promote neochondrogenesis from perichondrium. Human amniotic fluid contains hyaluronic acid, growth factors and extracellular macromolecules, and may, therefore, have a stimulating effect on cartilage regeneration. This experimental study investigated the effect of human amniotic fluid on cartilage regeneration from rabbit ear perichondrial flaps, using 96 ears of 48 New Zealand young rabbits. A perichondrial flap was elevated and a cartilage defect measuring 20 mm x 15 mm was created on the dorsum of each ear, then the perichondrial flap was sutured in place. The ears were divided into two groups according to the solution injected underneath the perichondrial flap. The right ears, which were injected with 0.2 ml human amniotic fluid, formed the experimental group, and the left ears, which were injected with 0.2 ml saline, formed the control group. Macroscopic and histological progression of neochondrogenesis were evaluated at 2, 4, 6 and 8 weeks after surgery. Macroscopically, the cartilage in the experimental group was generated quickly and had a similar appearance to the surrounding cartilage tissue, whereas in the control group minimal cartilage formation was observed at 4 weeks. Histologically, the neocartilage was significantly thicker in the experimental group than in the control group at 8 weeks (P < 0.05, Student's t -test). It can be concluded that human amniotic fluid enhances new cartilage formation from rabbit ear perichondrial flaps. The preventive effect of human amniotic fluid on scar formation and the rich content of growth factors and extracellular matrix precursors may play a role in this result.     

尿道口蒂皮瓣与口腔黏膜联合一期修复尿道下裂

目的探讨尿道口蒂皮瓣与口腔黏膜对合重建尿道的方法.方法 2002年3月～2004年5月,采用尿道口蒂皮瓣与口腔黏膜联合重建尿道21例,年龄14个月～8岁.切断挛缩尿道板,彻底矫直阴茎后,将口腔黏膜移植于阴茎腹侧白膜,尿道口蒂皮瓣翻转后与口腔黏膜对合,形成管状尿道.结果术后所有患儿均获3～18个月随访,平均7个月.阴茎弯曲完全矫正,尿道外口位于阴茎头前端,阴茎外形良好,排尿通畅.2例发生尿瘘,其中1例自愈,1例术后6个月再修补成功.结论尿道口蒂皮瓣与口腔黏膜联合重建尿道能彻底矫正阴茎弯曲,提高手术成功率和改善术后阴茎外形.     

Fricke supraorbital flap for reconstruction of total lower eyelid defects

Summary Split or full thickness eyelid defects resulting from tumor destruction or surgical excision present a dilemma for plastic and reconstructive surgeons. Full thickness eyelid replacement requires composite grafting of the skin, together with tarsal support of its substitute and mucosa. The flap described by Fricke in 1829 was used for reconstruction of anterior lamella in six lower eyelid defects. In three of our cases chondromucosal grafts taken from nasal septum were utilized for posterior lamella repair. The results have been satisfactory from a functional and cosmetic standpoint.     

Die Verwendung von Mundschleimhaut in der Harnröhrenchirurgie

Buccal mucosa grafts have proven reliable in urethral surgery. For augmentation urethroplasty, the graft can be used as a ventral or dorsal onlay. If the graft was used as an onlay, the results were much better than in substitution urethroplasty with the graft used as a tube. In patients with complex strictures or severe cases of hypospadias or epispadias, a two-stage technique using a buccal mucosa inlay graft can be applied. After 6 months, the well-revascularized buccal mucosa strip can be tubularized and covered with a tunica dartos or tunica vaginalis flap.In the future, for correction of larger defects, buccal mucosa cells can be cultured in vitro on biodegradable matrices. These larger buccal mucosa transplants could minimize the morbidity at the donor site. Future studies must clarify if the new technology of nanofibers can be of advantage by producing better matrices.     

Tracheal reconstruction with porcine small intestine submucosa in a rabbit model

OBJECTIVE: To evaluate the ability of porcine small intestine submucosa (SIS) to 1) maintain airway patency, 2) integrate, 3) prevent granulation tissue formation, and 4) permit mucosalization when used for tracheal reconstruction. Further studies were performed to evaluate the ability of SIS to support neochondrogenesis and investigate the impact of neochondrogenesis on airway patency. STUDY DESIGN: Prospective, controlled animal trial with SIS used with and without a perichondrial flap to reconstruct a tracheal defect in a rabbit model. Functional, histologic and endoscopic analyses were performed. RESULTS: All animals except 1 control animal were without stridor. The SIS graft supported neochondrogenesis, was completely mucosalized and was well integrated into the neotrachea. There was minimal granulation tissue formation. Endoscopic analyses did not reveal a consistent, significant difference in airway patency when SIS, with or without a perichondrial flap, was used for reconstruction. CONCLUSION: SIS can be used to reconstruct a sublethal rabbit tracheal defect with no mortality and minimal morbidity.     

舌黏膜与颊黏膜或包皮拼接重建尿道治疗长段尿道狭窄

目的 探讨舌黏膜与颊黏膜或包皮拼接尿道成形治疗多节段或长段尿道狭窄的安全性和治疗效果.方法 尿道狭窄患者11例,年龄24～56岁,平均32岁.其中前尿道长段狭窄7例,狭窄长度10～15 cm,平均12 cm;尿道2～3处狭窄4例.病程6个月～8年.取舌黏膜条与颊黏膜条拼接尿道成形治疗7例,舌黏膜条与包皮瓣拼接尿道成形治疗4例.结果 11例手术顺利.1例舌黏膜与包皮拼接尿道成形患者术后3个月并发尿道外口狭窄,经手术矫正后排尿通畅,术后8个月最大尿流率27.5 ml/s.余10例排尿通畅、尿线粗,术后随访5～12个月,平均10个月,最大尿流率21～36 ml/s,平均26.8 ml/s.结论 舌黏膜与颊黏膜或包皮拼接尿道成形具有取材方便、患者创伤小的特占点,是治疗长段尿道律窄的较好术式.尤其适用于尿道多处狭窄者.