One-stage reconstruction of nasal defects: evaluation of the use of modified auricular composite grafts

Complex nasal defects in the distal regions of the nose are cosmetically difficult to repair. In 70 patients over a period of 10 years, defects of the nasal ala and the soft triangle, nasal tip, columella, and columellar-lobular junction were reconstructed with modified auricular composite grafts. A randomized group of 40 of these patients was assessed after a mean of 55.5 months to evaluate the method's functional and cosmetic long-term results. The majority of the patients (60%, N?=?48) had been treated primarily for basal cell carcinoma. Of all defects, 57% ( N?=?46) measured 2 to 3 cm in width and 43% ( N?=?34) 1 to 2 cm. Seventy-five percent ( N?=?60) of all defects were composite lesions involving skin, cartilage, and vestibular mucosa, in contrast to 25% ( N?=?20) involving skin and cartilage with intact vestibular skin. Two crucial technical modifications seemed to have improved survival for larger grafts: first, the use of hinge flaps from the margins of the defect to obtain a well-vascularized recipient bed and optimization of the raw contact surface; second, postoperative gentle scarification of the graft in combination with a constantly applied heparin solution decongests venous stasis normally seen in such grafts. This maneuver establishes a stable and early blood supply enhancing graft take. With this type of treatment, 67 (84%) grafts healed well without further complications, whereas 13 (16%) grafts developed complications, resulting in partial ( N?=?9) and total ( N?=?4) necrosis of the transplant. Six of these patients underwent a secondary reconstruction using another auricular composite graft. Long-term results of this method have turned out to be very satisfying in terms of functional and cosmetic outcome and patient acceptance.     

同种异体大块髂骨重建自体大块髂骨供骨后骨缺损的研究

骨不连、骨缺损的治疗是骨科医生常面临的一个问题。自体骨因兼有骨诱导活性和骨传导作用，且具有成骨作用的骨髓细胞，成骨效果最好，故目前仍是植骨的“金标准”。虽然植骨材料目前有同种异体骨、异种骨、人工骨等多种选择，但在已严重骨缺损、骨萎缩的骨不连端，仍需要取含丰富松质骨的大块髂骨进行植骨。临床上常可见到患者术后供骨区不同程度的慢性疼痛、局部组织塌陷、髂嵴部变形等并发症.     

Reconstruction of metastatic acetabular defects using a modified Harrington procedure

Background and purpose — Metastases engaging the acetabulum result in significant disability. We investigated the outcome after curettage and reconstruction of the defect with a protrusio cage, retrograde screws, and a cemented total hip arthroplasty.

Patients and methods — We retrospectively identified 70 consecutive patients who were surgically treated for metastatic disease of the acetabulum between 1995 and 2012 using the above technique. The type of primary tumor, extent of the disease, degree of acetabular erosion, and type of implant used were identified. Patient and implant survival, complications, and functional outcome were recorded.

Results — There were no mortalities in the perioperative period (30 days after surgery). Median overall patient survival was 12 months. Prosthesis survival was 92% at 1 year and 89% at 5 years. One third of the patients suffered a complication, the most frequent one being dislocation. The functional outcome was good. Multiple skeletal or visceral metastases and specific types of cancer were associated with poor patient survival.

Interpretation — Reconstruction of metastatic acetabular defects using a protrusio cage stabilized with retrograde screws and a cemented total hip arthroplasty is a safe procedure that provides efficient relief of symptoms. Patients with extensive disease, especially when diagnosed with specific types of cancer, have a very poor prognosis. The complication rate is substantial, the most frequent being dislocation. However, revision surgery is seldom required and prosthesis survival is high.     

Reconstruction of large defects of the abdominal wall using dermal and synthetic grafts

Large defects of abdominal wall (greater than 8 cm in diameter) related to different cause, are still difficult problem of modern surgery. The best results in order to obtain safe and permanent anatomical and functional abdominal wall integrity are reached by autogenous dermal and synthetic grafts. Controversies concerning quality of these procedures are still presents. Our work is based on two equal experimental groups of 20 Vister rats each, with large artificial abdominal wall defects: one treated with autogenous dermal graft, another with synthetic Mersilene mesh graft. The animals from both groups were sacrificed in previous planned time intervals (3rd, 7th, 14th and 48th days). Afterwards detailed microscopic and gross examination of abdominal wall reparation and quality of reconstructed abdominal wall defects had been performed. According to our results both methods are easy to be performed and safety surgical procedures. Overestimated usage of synthetic grafts should be diminished because of advantages of autologous dermal graft--availability, substitution of firmly fibrosis tissue and endurance against infection.     

吻合血管的逆行游离耳前皮瓣移植修复鼻部分缺损

目的旨在设计以颞浅动脉远端为蒂的逆行游离耳前皮瓣进行吻合血管的移植一期修复鼻部分缺损。方法本组共3例,1例为鼻尖缺损,1例为右侧鼻翼缺损,1例为鼻尖缺损、右侧鼻翼完全缺损及左侧鼻翼不完全缺损。术中将游离逆行耳前皮瓣的颞浅动、静脉分别与鼻唇沟部面动、静脉吻合,其中1例急诊患者颞浅静脉是与下睑伤口的一条静脉吻合。结果逆行游离耳前皮瓣大小范围为3.0 cm×2.5 cm~6 cm×2 cm,血管蒂长5~6 cm。3例患者皮瓣均成活,再造的鼻尖、鼻翼外形逼真,皮肤色泽、质地与鼻部皮肤接近。耳前供区切口隐蔽不遗留明显瘢痕。结论耳前皮瓣皮肤颜色、质地与鼻部接近,皮瓣血管蒂长,不需要血管移植,可通过显微外科技术一期修复鼻部分缺损,该皮瓣也可用于面部其他皮肤缺损的修复。     

游离髌骨移植修复膝部半髁骨缺损手术方法

[目的]探讨髌骨移植对股骨下端或胫骨上端半髁骨缺损修复的治疗效果,提出手术步骤和方法.[方法]本组骨巨细胞瘤患者7例,病史4～12个月,平均5.8个月.男4例,女3例;年龄18～40岁,平均31.8岁.股骨下端4例,胫骨上端3例,按Ennecking外科分期,2期5例,3期2例.用髌骨关节面代替股骨或胫骨髁关节面修复和重建骨缺损.[结果]随访时间3～10年,3例5年以上,平均4.9年.随访期间无复发转移,无髌骨坏死和感染,移植骨愈合良好.根据国际保肢学会功能评分标准,关节功能优3例,良4例.术后主要并发症为关节活动范围减小,范围40°～110°,平均88°.术后伸膝肌力下降不明显,1例胫骨平台轻度下沉,1例于术后6年出现关节疼痛.[结论]膝关节上下侵犯关节软骨的骨巨细胞瘤,行包括肿瘤在内的一侧髁切除后,可以用游离髌骨移植修复和重建骨缺损.     

Reconstruction of fingertip defects with great toe pulp grafts

Various methods have been used to treat fingertip defects that are caused when distal parts are amputated. In this study, we used the pulp graft harvested from the lateral aspect of the great toe. Between September 2004 and August 2006, the great toe pulp graft were performed on 16 patients. The ages of patients ranged from 4 to 58 years. The average follow-up duration was 28 months. Complete graft take was observed in 13 of 16 patients. Partial necrosis was observed in 2 patients, and total necrosis in 1 patient. The pulp graft was painless and the color and texture of the graft were similar to the adjacent skin. Semmes-Weinstein monofilament and 2-point discrimination tests showed good recovery of fingertip sense. The scar of the fingertip was assessed by Vancouver Scar Scale and Cold intolerance by Visual Analog Scale and the results were satisfactory and also improved with time. The recipient site wasclosed with little scar. There were no gait disturbances. To conclude, the great toe pulp graft can provide soft-tissue and sensory recovery in fingertip defects.     

Reconstruction of patellar cartilage defects with free periosteal grafts. An experimental study

The osteo-chondrogenic potential of free periosteal grafts was investigated within the knee joint in 26 rabbits aged four to six weeks. A total of 36 knee joints were operated on. The grafts were stripped from the medial side of the right tibia and sutured on the articular surface of the patella, from which the cartilage had been totally excised to the subchondral bone. In 16 knees the graft was sutured with the cambium layer towards the subchondral bone and in eight knees the fibrous layer faced the bone. In the control group of twelve knees the patellar articular cartilages were excised and no periosteal transplant was grafted to the patellar articular surface. In the transplantation group cartilage formation could be seen already one week after the operation. There were no marked differences between the series with the cambium layer facing the subchondral bone or the group with the fibrous layer facing the bone. At 20 weeks the hypertrophied cartilage had thinned and resembled normal joint cartilage. In the control group the histological picture resembled osteoarthritis.     

Reconstruction of the nasal tip including the columella and soft triangle using a mastoid composite graft.

This paper describes the use of a composite graft from the mastoid area consisting of full-thickness skin peripherally and selectively localised fascia-fat tissue underneath the skin centrally for immediate reconstruction of moderate defects of the nasal tip including the columella and soft triangle. Mastoid composite grafting is a simple and safe procedure that avoids partial graft loss and provides adequate augmentation of soft tissue, easy reshaping of the new nostril rim, minimal post-operative shrinkage, and no donor-site morbidity. Then, it results in a satisfactory nasal appearance with adequate tip projection and symmetry. This procedure may represent a preferred method of nasal tip reconstruction.     

Reconstruction of complex defects with composite calvarial flaps

Over the past four years, composite calvarial flaps have been used to reconstruct complex defects in 14 patients. In three of the patients they were free flaps for hand reconstruction. Clinical application (technical details) and complications are also discussed.     

Reconstruction of femoral vein using ePTFE grafts

Rare cases of reconstruction of peripheral veins were reported. We experienced two patients with liposarcomas of the thigh in which the femoral vessels were resected with the tumor and reconstructed with ePTFE grafts. In a 51-year-old male, the left femoral vein was reconstructed with an ePTFE graft 6 mm in diameter and 11 cm in length; but the graft occluded early in the postoperative period. In another case, a 33-year-old male, the right femoral vein was reconstructed with a ringed ePTFE graft 8 mm in diameter and 9 cm in length, with an arterio-venous fistula. The graft maintained its patency for 7 months after surgery.     

Reconstruction of skeletal defects in the femur with 'two-strut' free vascularized fibular grafts.

Large skeletal defects of the femur caused by infected nonunions remain a challenge to orthopedic surgeons. Conventional bone grafting may not succeed when the recipient bed is not ideal. Single fibular grafts were proven very useful in bridging this type of defect, yet were complicated by the high incidence of refracture and the need for protection of long duration. By dividing the fibula into two struts connected by the nutrient vessels, we doubled the effective cross-sectional area of bone grafting with only one set of vascular anastomoses. Five cases of infected nonunion of the femur after a high-energy trauma were successfully managed with this technique. All the fractures healed in an average of 7 months. By 1 year the grafts hypertrophied to the size of the femur. A follow-up of at least 2 years recommends this technique in the management of certain chronic osseous defects of the femur.     

耳郭复合组织瓣修复鼻底部分缺损

目的　灵活运用耳郭复合软骨组织瓣修复鼻底部分缺损畸形。方法　采用耳郭中上部复合软骨组织修复鼻翼缺损 ,下部修复鼻小柱缺损 ,耳垂缘皮肤脂肪复合组织修复鼻尖缺损。结果　随访患者 6个月至 3年 ,除 1例患者鼻翼缺损 ,因加压不彻底 ,复合组织块外侧缘有 1.0mm× 1.5mm坏死外 ,其余复合组织瓣均成活。结论　在牢固掌握血供原则下 ,手术方法简单 ,外形效果较好 ,是该部位修复的首选方法     

耳郭复合组织瓣修复鼻底部分缺损

目的灵活运用耳郭复合软骨组织瓣修复鼻底部分缺损畸形.方法采用耳郭中上部复合软骨组织修复鼻翼缺损,下部修复鼻小柱缺损,耳垂缘皮肤脂肪复合组织修复鼻尖缺损.结果随访患者6个月至3年,除1例患者鼻翼缺损,因加压不彻底,复合组织块外侧缘有1.0 mm×1.5 mm坏死外,其余复合组织瓣均成活.结论在牢固掌握血供原则下,手术方法简单,外形效果较好,是该部位修复的首选方法.