Successful repair of ascending aortic pseudoaneurysm using autograft patch from fascia lata and saphenous vein

An 80-year-old man developed a pseudoaneurysm in the ascending aorta due to mediastinitis following cardiac surgery. We successfully repaired the pseudoaneurysm with an autograft patch harvested from fascia lata and the saphenous vein. The repair, which was carried out in two layers, can be expected to be durable.     

Medial migration of lag screw after gamma nailing

Fractures of the proximal femur are common in the elderly population. Intramedullary nailing has become the standard treatment for intertrochanteric fractures although several extramedullary implants (e.g. dynamic hip screw (DHS), blade plate, locking compression plate (LCP), etc.) exist. However, despite this being a very common operation in traumatology, there are numerous associated complications. We report the rare complication of the migration of the medial lag screw into the pelvis at five and a half weeks postoperatively. The implant was removed and replaced by a total hip arthroplasty with simultaneous grafting of the acetabular defect and strapping of the greater trochanter. The evolution was favourable. We also present a review of the literature and analyze our case.     

眶外缘眼轮匝肌舒平悬吊法在除皱术中的应用

目的：探讨除皱术中应用眶外侧眼轮匝肌舒平悬吊法矫正鱼尾纹和外眼角下垂的效果。方法：除皱术中采用眼轮匝肌浅面分离至外眦,彻底松解鱼尾纹;再将眶外侧眼轮匝肌外缘向外、上方舒平并悬吊至颞浅筋膜,矫正鱼尾纹和外眼角下垂。结果：此法2003-2010年临床应用591例。就医者随访2～51个月,鱼尾纹和外眼角下垂改善效果明显,无并发症。结论：此手术方法操作简单,有效矫正了鱼尾纹和外眼角下垂,是一种行之有效的除皱方法。     

瘢痕硬度测定计的研制及临床应用

为了达到无创伤、客观、定量测定瘢痕硬度的目的,设计制造出瘢痕硬度测定计,并用以测定了50例病人增生性瘢痕治疗前、治疗后1、2、3个月瘢痕的硬度以及相邻正常皮肤的硬度。研究结果表明:本硬度测定计重复性好,精密度达到质控标准;所测定的硬度值在瘢痕和正常皮肤有极显著差异,作为判断瘢痕特征指标有特异性;瘢痕硬度在治疗后3个月<2个月<1个月<治疗前,说明用于监测瘢痕疗效和成熟度具有临床实用价值。     

瘢痕硬度测定计的研制及临床应用

为了达到无创伤、客观、定量测定瘢痕硬度的目的，设计制造出瘢痕硬度测定计，并用以测定了５０例病人增生性瘢痕治疗前、治疗后１、２、３个月瘢痕的硬度以及相邻正常皮肤的硬度。研究结果表明：本硬度测定计重复性好，精密度达到质控标准；所测定的硬度值在瘢痕和正常皮肤有极显著差异，作为判断瘢痕特征指标有特异性；瘢痕硬度在治疗后３个月＜２个月＜１个月＜治疗前，说明用于监测瘢痕疗效和成熟度具有临床实用价值。     

Medial migration of intramedullary hip fixation devices: a biomechanical analysis

Introduction Intramedullary nails for fixation of extracapsular hip fractures have gained popularity recently. Although clinically successful, they are not devoid of complications. An infrequently reported complication is the medial migration of the femoral neck element (FNE) of the implant into the pelvis. The purpose of this study was to create a biomechanical model simulating this effect based on a clinical case radiographic analysis. Methods Eight clinical cases of medial migration were available for radiographic analysis. Medial migration was quantified and the fractures were classified. A biomechanical model was built comprising two fixtures containing the nail and FNE respectively. A pivot between the two fixtures, representing a deficient femoral calcar, simulated an unstable fracture type. Two pivot points were used for each nail. The constructs were tested using sinusoidal loading (40–800 N at 2 Hz) and medial migration was assessed. Five different nail designs (TFN, PFN, PFN-a, Gamma-3 and IMHS) were tested (overall 75 tests). Results All the five implants demonstrated medial migration to a similar distance. The TFN required the highest number of cycles (3127 ± 2569) and the IMHS the lowest (58.8 ± 3.6) although this difference did not reach statistical significance (P = 0.07). Changing the pivot point for the medial calcar did not alter the results significantly. All eight clinical cases demonstrated an unstable intertrochanteric fracture pattern (AO/OTA 32A2). Conclusions Discrete biomechanical conditions are required to reproduce medial migration of the FNE in cephalomedullary devices.     

110例瘢痕临床分析及微循环组织化学观察

为了研究瘢痕的成因、类型及分布情况，作者对１１０例要求手术治疗的皮肤瘢痕患者的临床资料进行了分析。结果表明，瘢痕的成因以烧伤居首位，感染次之。瘢痕在躯体的分布以颜面为最。瘢痕的类型则以萎缩瘢痕最常见，次为增生瘢痕。在求治者中，瘢痕形成１０年以上者占６０％，１～３年占２４．５５％。介绍了应用酶组化“碱性磷酸酶反应”染色法（钙铅法）对瘢痕微循环组织化学观察的结果，对其优点进行了讨论。     

广泛皮肤扩张术修复面颈胸部烧伤后瘢痕

目的：探讨广泛皮肤扩张术修复面颈,胸部烧伤后瘢痕的治疗效果。方法：采用一次多个扩张器置入面颈,胸部正常皮肤下,经广泛扩张皮肤后修复瘢痕,切除瘢痕散在,畸形比较严重的创面共计13例,置入的扩张器数量及大小依瘢痕畸形程度不同为5－8个,扩张容积30－450ml不等。手术遵循整形外科设计原则,尽可能使修复后的切口处于顺皮纹或隐蔽处,以面部器官正确复位,颌颈角正常,上胸部避免植皮为治愈标准,结果：13例面颈,胸部散在瘢痕切除均一次性完成,皮瓣全部成活,其质地,色泽理想,面部器官,颈胸部外观与功能较好,结论：采用广泛皮肤扩张术修复面颈胸部烧伤后瘢痕,是一种较好的方法。     

Use of makeup, hairstyles, glasses, and prosthetics as adjuncts to scar camouflage

Scars after facial trauma or surgery can be a source of distress for patients, and facial plastic surgeons are frequently called upon to help manage them. Although no technique can remove a scar, numerous treatment modalities have been developed to improve facial scar appearance with varying levels of invasiveness. This article reviews techniques that camouflage scars without surgical intervention. Topical scar treatments, camouflage cosmetics, use of hairstyling and glasses, and facial prosthetics are discussed. In addition, professional counseling is provided on selection and application of topical cosmetics for use as part of an office practice.     

增生性瘢痕和瘢痕疙瘩中PKC活性测定

目的　测定增生性瘢痕和瘢痕疙瘩等瘢痕组织中PKC活性变化 ,探讨PKC在瘢痕形成中的作用。方法　利用PKC活化后催化底物多肽磷酸化 ,然后计数底物中掺入32 P的放射活性的原理 ,测定增生性瘢痕、瘢痕疙瘩、成熟瘢痕和正常皮肤组织中PKC活性。结果　增生性瘢痕和瘢痕疙瘩组织中PKC的活性显著高于成熟瘢痕和正常皮肤 (P <0 .0 0 1,分别高出正常皮肤 318.30 %和 5 19.0 7% ) ,瘢痕疙瘩高于增生性瘢痕 (P <0 .0 0 1,高出 48.6 0 % )而成熟瘢痕和正常皮肤间没有差异 (P >0 .0 5 )。结论　瘢痕组织中PKC活性升高且与增生程度相关 ,提示PKC可能参与了细胞增殖和合成物质的信号转导     

HER2在病理性瘢痕组织中的蛋白表达、基因扩增及其临床意义

目的 探讨人类表皮生长因子受体2（HER2）在正常皮肤组织、成熟性瘢痕及病理性瘢痕中的表达及其临床意义.方法 采用免疫荧光原位杂交和组织芯片免疫组化学链菌素亲生物素-过氧化酶连接法,检测正常皮肤10例、成熟瘢痕16例、增生性瘢痕9例和瘢痕疙瘩40例中HER2蛋白表达及基因扩增情况.结果 正常皮肤、成熟瘢痕、增生性瘢痕及瘢痕疙瘩中,HER2蛋白阳性表达率分别为0、25.00%、66.67%、85.00%;基因扩增阳性率分别为0、12.50%、55.56%、80.00%.病理性瘢痕中HER2蛋白表达水平、基因扩增阳性率均较高,与正常皮肤、成熟性瘢痕比较,差异具有统计学意义（P ＜0.05）.结论 HER2在病理性瘢痕中表达增强,提示HER2可能参与了病理性瘢痕的形成,故针对HER2靶向治疗瘢痕,有一定的临床应用前景.     

丹参氮酮助渗液对瘢痕治疗作用的探讨

目的　观察 5 %丹参氮酮助渗液对瘢痕的治疗效果并探讨其作用机理。方法　进行离体大鼠皮肤、活体及离体人皮肤对 5 %丹参氮酮助渗液的通透效果测定。并将应用硅膜弹力布贴膏治疗的 30 1例增生性瘢痕患者分成治疗组和对照组 ,治疗组使用含 5 %丹参氮酮助渗液的布贴膏 ,对照组则不含 ,对两组进行临床疗效观察比较。结果　离体大鼠皮肤通透试验经Poisson级数差别检验 ,差异有非常显著性意义 (χ2 =84 6 32 98,P <0 0 1) ;活体及离体人皮肤的通透效果测定 ,差异有非常显著性意义 (χ2 =15 9,P <0 0 1) ,说明 5 %丹参氮酮助渗液透皮效果良好 ;临床观察治疗组总有效率为 91 4 % ,对照组总有效率为 71 3% ,治疗组明显优于对照组。结论　 5 %丹参氮酮助渗液可以渗入皮肤 ,能显著降低皮肤电阻值 ,增加皮肤通透性 ,与硅膜弹力布贴膏合用对瘢痕有着良好的治疗效果。     

颈部重叠埋置皮肤扩张器扩张修复颌面颈部瘢痕

目的探讨在颈阔肌的浅层重叠埋置皮肤扩张器的皮肤扩张技术在颌面颈部瘢痕挛缩畸形修复中的应用及效果。方法在颈阔肌浅面的同一剥离腔隙内重叠埋置2个扩张器,按期注水扩张,4～6周后行扩张器Ⅱ期手术。结果自2004年以来应用这一技术整形修复颌面颈部瘢痕挛缩畸形16例,除1例颈部重叠埋置扩张器患者于晚期出现扩张器外露,及时手术处理后未影响最终手术效果外,其余均取得良好效果。结论扩张器重叠埋置扩张技术与传统的皮肤扩张术相比,在相同时间内可提供更多的可利用的扩张皮肤,降低了与扩张术有关的并发症的发生率,特别是在颈阔肌浅面的重叠埋置扩张尤为适用于颌面颈部瘢痕的整形修复。     

成纤维细胞内肌动蛋白、钙离子与瘢痕挛缩的相关研究

目的　探讨增生性瘢痕、瘢痕疙瘩成纤维细胞中肌动蛋白 (actin)和钙离子 (Ca2 + )含量与瘢痕挛缩的关系。方法　取两类瘢痕各 10例 ,蛋白质电泳及凝胶扫描测定成纤维细胞内总肌动蛋白 ,聚合 (F肌动蛋白 )、球 (G肌动蛋白 )肌动蛋白及F/G肌动蛋白比值。Fura 2荧光探剂标记、图像分析胞内Ca2 + 浓度。结果　增生性瘢痕总肌动蛋白 [(2 .3 8± 0 .3 5 )ng/10 4细胞 ]、F肌动蛋白 [(0 .98± 0 .19)ng/10 4细胞 ]、F/G肌动蛋白比值 (0 .68± 0 .0 7)、Ca2 + 浓度 (82 .64± 10 .0 0 )均明显高于瘢痕疙瘩总肌动蛋白 [(1.68± 0 .2 5 )ng/10 4细胞 ]、F肌动蛋白 [(0 .46± 0 .10 )ng/10 4细胞 ]、F/G肌动蛋白比值 (0 .3 6± 0 .0 5 )及Ca2 + 浓度 (73 .2 6± 2 .5 5 ) (P <0 .0 1)。G 肌动蛋白含量差异无显著性 (P >0 .0 5 )。结论　成纤维细胞内肌动蛋白与钙离子浓度的改变 ,是造成两类瘢痕不同挛缩特性的重要原因。     

皮肤外牵拉扩张器的研制与皮肤瘢痕的治疗

目的 为了达到在一定范围内皮肤瘢痕及其他病损皮肤切除后刨面可以直接拉拢缝合.方法 用自行研制的皮肤外牵拉扩张器,定时定量行病损区周围正常皮肤的外牵张,使之逐渐扩延和松动.结果 对28例大面积皮肤瘢痕患者行皮肤外牵引扩张后,一次性切除瘢痕,可以直接拉拢缝合创面,均达到Ⅰ期愈合.结论 应用皮肤外牵拉扩张器行皮肤外牵引扩张,是治疗皮肤瘢痕及其他病损较理想的方法.     

人重组干扰素-α及白细胞介素-2对病理性瘢痕成纤维细胞增殖的影响

目的　观察人重组干扰素- α(rhIFN-α)及白细胞介素-2 (rhIL-2 )对病理性瘢痕成纤维细胞生物学行为的影响 ,探讨细胞因子对病理性瘢痕的作用机制。方法　对 5例临床病理性瘢痕标本进行成纤维细胞体外培养 ,采用流式细胞术方法进行观察、分析 ,以研究细胞因子rhIFN-α及rhIL-2 (浓度分别为 2 5 0 ,5 0 0 ,75 0U/ml ,每组数n =6)对病理性瘢痕成纤维细胞增殖、细胞周期、Fas、Bcl-2表达量的影响。结果　加入rhIFN-α 72h后检测 ,S-G2-M期细胞百分数降低 (P <0 .0 5 ) ,Fas、Bcl-2蛋白表达量 ,分别显示升高 (P <0 .0 5 )和降低 (P <0 .0 5 ) ;加入rhIL-2后S-G2-M期细胞百分数明显升高 (P <0 .0 1) ,Fas、Bcl-2蛋白表达量 ,两者均有升高 (P <0 .0 5 ,P <0 .0 1)。结论　rhIFN-α是成纤维细胞负性调节因子 ,对成纤维细胞的生长趋势及增殖活性有明显抑制作用。rhIL-2作为成纤维细胞正性调节因子 ,促进成纤维细胞的生长增殖。     

survivin和caspase-3在病理性瘢痕成纤维细胞中的表达及其意义

目的研究病理性瘢痕成纤维细胞中survivin和caspase-3的表达水平，以及两种凋亡相关因子与病理性瘢痕发生、发展机制的关系。方法以普通瘢痕为对照，采用RT—PCR和免疫组化方法，研究体外培养的病理性瘢痕成纤维细胞中survivin和caspase-3 mRNA和蛋白的表达变化，并进行比较分析。结果病理性瘢痕成纤维细胞中survivin的mRNA和蛋白（65．47％、72．43％）的表达水平高于普通瘢痕（P〈0．01）；caspase-3的mRNA和蛋白表达水平低于普通瘢痕（22．85％、6．34％，P〈0．01）；survivin、caspase-3在增生性瘢痕和瘢痕疙瘩中的表达差异有统计学意义（P〈0．05）。结论survivin和caspase-3在病理性瘢痕成纤维细胞中的表达异常。在病理性瘢痕的发生、发展中起重要的作用。     

增生性瘢痕和瘢痕疙瘩中PTK活性测定

目的测定增生性瘢痕和瘢痕疙瘩组织中PTK活性变化,探讨PTK在瘢痕形成中的作用。方法利用活化的PTK催化底物多肽磷酸化,再计数底物中掺入32P的放射活性的原理,测定增生性瘢痕、瘢痕疙瘩、成熟瘢痕和正常皮肤组织中PTK活性。结果增生性瘢痕和瘢痕疙瘩组织中PTK的活性显著高于正常成熟瘢痕和正常皮肤（P＜0.001,分别高出正常皮肤150.80%和313.80%）,瘢痕疙瘩高于增生性瘢痕（P＜0.001,高出65.01%）而成熟瘢痕和正常皮肤间没有差异（P＞0.05）。结论瘢痕组织中PTK活性升高且与增生程度相关,PTK介导生长刺激的信号转导使细胞增殖和合成物质的功能增强而发生瘢痕增生。     

Reduction of pain in the treatment of vascular lesions with a pulsed dye laser and pneumatic skin flattening

The treatment of vascular lesions, including port wine stains (PWSs), with a pulsed dye laser is very painful and often requires general anaesthesia. This is particularly problematic with children. Pneumatic skin flattening (PSF) is a new technology that naturally reduces pain in laser-based aesthetic treatments. The objective of this study was to test pain reduction, as well as lesional clearance, by combining pneumatic skin flattening (PSF) technology with a pulsed dye laser in the treatment of vascular lesions. Twenty-one patients (three of them children) were treated for vascular lesions, mostly PWSs (13 patients). The patients were treated with a 595 nm pulsed dye laser operated at energies of 5.75–13.25 (median 9.25) J/cm². Acute pain was evaluated in all 21 patients. Topical anaesthetic (EMLA cream) was applied before treatment in six cases. Identical energies were applied to both sites. The pain during PSF treatment was compared to pain during regular treatment without PSF. Blanching response to treatment was evaluated in 18 patients after 6–12 weeks. Significant pain reduction was observed in 21/21 patients (100%). The average reduction in pain score was from 10 without PSF (painful) to 2.6 with PSF (comfortable). Follow-up examination of 18 patients after 6–12 weeks showed identical blanching of tissue in both the PSF-treated areas and those not treated with PSF in all patients. It was concluded that the PSF technology significantly reduced pain in the treatment of vascular lesions with a pulsed dye laser without affecting efficacy.