碱性成纤维细胞生长因子在自体脂肪游离移植中血管生成的早期作用

应用碱性成纤维细胞生长因子于自体脂肪游离移植，以刺激移植体早期的血管形成。移植脂肪在对照侧单纯加入纤维蛋白；实验侧加入含有ｂＦＧＦ的纤维蛋白。动物术后存活５、７、１０天。各期动物经心脏主动脉插管，灌注墨汁。结果显示各期实验侧移植物中血管生成密度均明显高于对照侧。     

血管铸型观察bFGF对大鼠颌面部移植脂肪新生血管的影响

目的为探讨碱性成纤维细胞生长因子（ｂＦＧＦ）在自体游离脂肪中血管形成的作用。方法以ＳＤ大鼠双侧嚼肌区皮下作为受植床，取腹股沟区脂肪切碎后，实验侧加入ｂＦＧＦ，并以纤维蛋白作为ｂＦＧＦ的缓释剂；对照侧加入单纯纤维蛋白进行移植。术后７天，经心脏主动脉插管，以液体铸型材料甲烯丙烯酸甲脂、丙烯酸甲酯灌注制作移植体血管制作后，在ＪＳＭ－Ｔ３００型扫描电镜下观察血管走向、形态并计量分析。结果移植脂肪内血管多从颈向头方行走，皮肤侧比嚼肌侧丰富，实验侧大量血管呈芽突状，芽突顶端及侧方有深而长的椭圆或圆形内皮细胞核压迹，新生血管明显偏粗。结论ｂＦＧＦ作为外源性因子加入自体游离移植脂肪内可诱导血管长入，增加移植组织中血管的数量及增大新生血管直径的作用。     

小颗粒脂肪移植碱性成纤维细胞生长因子及缓释剂浓度的正交筛选

目的解决游离脂肪移植吸收问题。方法根据碱性成纤维细胞生长因子（ｂＦＧＦ）的生物学特性，以纤维蛋白作为缓释剂，参与小颗粒状脂肪移植。并采用正交法设计，观察ｂＦＧＦ及缓释剂浓度与效应关系。结果术后３个月，移植物重量变化在差位级为９８％，好位级为２２５％。后者基本与动物体重同步增长。脂肪生存及增殖与ｂＦＧＦ缓释剂浓度关系密切。在０．２ｇ移植脂肪中加入ｂＦＧＦ１０００Ｕ、２０００Ｕ或４０００Ｕ，以４０００Ｕ效果最佳。缓释剂浓度１０００ｍｇ／Ｌ，２０００ｍｇ／Ｌ，或３０００ｍｇ／Ｌ，以１０００ｍｇ／Ｌ为佳。组织学观察各移植物均有被膜、纤维间隔。脂肪组织结构良好，细胞成熟。结论ｂＦＧＦ在以纤维蛋白为缓释剂条件下，对移植脂肪具有良好的促增殖作用。其效应具有浓度依赖关系     

碱性成纤维细胞生长因子在颗粒脂肪移植后血运重建过程的作用

目的 探讨碱性成纤维细胞生长因子对颗粒脂肪移植存活的作用。方法 在颗粒脂肪移植的实验动物模型应用碱性成纤维细胞生长因子，通过对不同时期实验侧和对照侧移植体血管密度的定量研究，观察血管生长情况。结果 微血管显影清晰。对照侧和实验侧术后各期血管密度逐渐增高。对照侧于28d达最高，实验侧于14d达最高，以后稍有下降。每组实验侧均高于对照侧。结论 碱性成纤维细胞生长因子可以有效促进颗粒脂肪移植的血管生长。     

重组人VEGF基因治疗提高游离颗粒脂肪移植存活率的实验研究

目的:研究重组人血管内皮生长因子(VEGF)基因治疗对大鼠游离颗粒脂肪移植存活的影响。方法:SD雄性大鼠36只,分三组,于游离颗粒脂肪移植后分别注入重组的VEGF质粒(目的基因组),空白质粒(空白质粒组)和生理盐水(生理盐水组)。于术后7、15、30天分别采集移植的脂肪组织,计算植入物校正重量比并行HE染色观察一般组织病理改变,同时使用免疫组化法测定组织的VEGF表达水平及微血管密度。结果:目的基因组在移植物重量改变方面显著小于空白质粒组及生理盐水组(P<0.05),其VEGF表达及微血管密度均显著高于其他两组(P<0.01),空白质粒组及生理盐水组差异无显著性意义。此外,在空白质粒组及生理盐水组镜下存在大量囊样脂池、坏死区。结论:皮下注射的转VEGF基因的质粒在组织中能够表达VEGF,并诱导新血管的形成,增加血流灌注,减少移植组织的吸收,促进移植脂肪存活。     

骨胶原的制备及作为骨形成蛋白载体修复骨缺损的研究

在提取ＢＭＰ的过程中，从废去的中间产物骨基质胶中同时提取胶原作为ＢＭＰ的载体用于修复兔颅骨缺损。４０只大白兔随机分为Ａ、Ｂ两组，在兔颅顶骨两侧对称各制造直径为１ｃｍ的圆形骨缺损，Ａ组兔颅顶骨缺损左侧植入骨胶原／ＢＭＰ，右侧植入单纯骨胶原。Ｂ超兔左侧植入ＢＭＰ，右侧空白对照，组织学检查显示：植入后７天，骨胶原／ＢＭＰ组即有软骨细胞岛出现，且在各期的成骨面积均大于单纯ＢＭＰ组和胶原组。另外，移植材料内     

转染VEGF基因提高游离自体颗粒脂肪移植物存活率的实验研究

目的 研究转染人血管内皮生长因子基因(VEGF)对大鼠游离的自体脂肪移植后移植物存活的影响.方法 SD大鼠48只,分为3组,每组16只.于自体游离颗粒脂肪移植时分别注入脂质体包裹的重组VEGF质粒(目的 基因组)和空白质粒(空白质粒组)以及生理盐水(生理盐水组).术后定期计算植入物后前重量比,并行HE染色观察组织病理改变,免疫组化法检测组织的VEGF表达水平及微血管密度.结果 目的 基因组在移植物重量改变方面显著小于空白质粒组及生理盐水组(P＜0.05),其VEGF表达及微血管密度均显著高于其他两组(P＜0.01),空白质粒组及生理盐水组差异无统计学意义.结论 脂质体包裹的VEGF基因质粒能够在脂肪组织中表达VEGF,诱导新血管的形成,减少移植组织的吸收.     

硬脑膜动静脉瘘动物模型的研究

目的 探讨硬脑膜动静瘘（ＤＡＶＦ）的发病机理。方法 （１）对照组：１０条犬,结扎并剪断右侧颈外静脉;（２）实验１组：１５条犬,吻合右侧颈外静脉远心端与以颈总动脉近心端;（３）实验２组：１５条犬,结扎并剪断左侧颈外静脉,然后与实验１组做相同处理。结果 对照组无ＤＡＶＦ发生;实验１组有３条犬发生ＤＡＶＦ;实验２组有１条犬发生ＤＡＶＦ。结论 单纯升高静脉窦内压力可以诱发ＤＡＶＦ。     

抗人甲胎蛋白异质体单克隆抗体放射免疫诊治肝癌的实验研究

放射性核素￣（１３１）Ｉ标记抗人小扁豆凝聚素结合型甲胎蛋白异质体单克隆抗体（ＡＦＰ－Ｒ－ＬＣＡＭｃＡｂ）后，经裸鼠腹腔注射，能选择性地在裸鼠实验性人类肝癌模型（简称：人肝癌）肿瘤区积聚，裸鼠人肝癌的放射性核素浓度是裸鼠肝脏的５．２倍，而￣（１３１）Ｉ标记的正常小鼠ＩｇＧ（ｍＩｇＧ）或游离￣（１３１）Ｉ却无瘤区积聚，且在荷瘤裸鼠体内呈均一性分布。￣（１３１）Ｉ标记单抗组γ照相均可清晰显示裸鼠所荷肝癌组织的阳性影象。实验发现，￣（１３１）Ｉ标记ＡＦＰ－Ｒ－ＬＣＡＭｃＡｂ后治疗荷人肝癌棵鼠，肿瘤生长受到明显抑制（８５％），其治疗效果优于￣（１３１）Ｉ－ｍＩｇＧ组、单纯核素组和单纯抗体组（４６％、２０％、７％、Ｐ＜０．０５）。结果表明，ＡＦＰ－Ｒ－ＬＣＡＭｃＡｂ对人肝癌细胞有较强的特异性和亲和力，有希望成为肝癌放射免疫诊断及治疗的理想载体。     

bFGF促进兔骨折愈合实验研究及临床应用

目的：通过动物实验验证ｂＦＧＦ 有促进骨折愈合的作用，并探索ｂＦＧＦ 临床应用效果。方法：对２０ 只兔手术造成桡骨骨折。局部注射ｂＦＧＦ，通过肉眼观察、Ｘ 线片，测量骨折、测定骨折愈合处骨密度、测定骨折愈合后的抗折力及病理学切片检查来观察骨折愈合情况。将应用于临床１１ 例骨折病人，骨延长、骨髓炎各２ 例，随访６ ～２４ 月。结果：注射ｂＦＧＦ 侧骨痂生长多而迅速，骨愈合处骨密度比对照组显著增高，抗折力比对照侧明显强。病理学切片显示注射ｂＦＧＦ 侧成纤维细胞多、骨痂多、成骨细胞多，骨小梁、骨基质形成快，骨折愈合快。临床１５ 例患者应用ｂＦＧＦ 后都有明显的促进骨折愈合，促进骨质生长、创口愈合的作用。结论：ｂＦＧＦ 有促进骨质愈合的作用。     

小颗粒脂肪移植碱性成纤维细胞生长因子及缓释剂浓度的正交筛选

OBJECTIVE: The experiment was designed to solve the problem that free fat transplantation survived at low percentage. METHODS: Based on physiochemical and biological characteristics of bFGF, fibrinogen was used as its carrier of sustained delivery. We applied bFGF and fibrinogen in pearl adipose transplantation. Different concentrations of bFGF and fibrinogen were used. The relation between the concentration of bFGF and fibrinogen and their effects on fat graft maintenance were observed. RESULTS: At three months after transplantation, the weight of the fat graft varied from 98% to 225%. The latter was approximately consistent with synchronous increase of the body weight of the animal. Weight increase of the graft was closely related to the concentration of bFGF and the sustained delivery carrier. When bFGF in the concentration of 4000 U/10 microliters and fibrinogen of 1000 mg% were applied, the fat graft obtained the greatest weight increase. Histologically, the structure of the transplanted fat was normal with fibrotic envelope and mature adipocytes. CONCLUSION: bFGF with fibrinogen as its carrier of sustained delivery favors the survival of fat graft and weight increase. The effects of bFGF and fibrinogen depend on their concentration.     

A physicochemical approach to improving free fat graft survival: preliminary observations

A different experiment approach to the problem of post-transplantation free fat graft resorption was evaluated. Bioactive free fat grafts were created through the addition of basic fibroblast growth factor (bFGF) carried on positively charged, hydrophilic, dextran beads to the grafts. This bioactive graft was compared with contralateral free fat grafts in the lateral facial areas of mature rats. After 90 days, when compared with the body mass increase of the animals, complete retention of the bioactive fat grafts occurred in contrast to the free grafts that exhibited loss of nearly half of their original weight. The histologic findings of small-sized adipocytes or adipocyte buds among larger adipocytes in the bioactive grafts raise the possibility of activation and induced differentiation of a preadipocyte cell line in these grafts.     

A physicochemical approach to improving free fat graft survival: Preliminary observations

A different experimental approach to the problem of post-transplantation free fat graft resorption was evaluated. Bioactive free fat grafts were created through the addition of basic fibroblast growth factor (bFGF) carried on positively charged, hydrophilic, dextran beads to the grafts. This bioactive graft was compared with contralateral free fat grafts in the lateral facial areas of mature rats. After 90 days, when compared with the body mass increase of the animals, complete retention of the bioactive fat grafts occurred in contrast to the free grafts that exhibited loss of nearly half of their original weight. The histologic findings of small-sized adipocytes or adipocyte buds among larger adipocytes in the bioactive grafts raise the possibility of activation and induced differentiation of a preadipocyte cell line in these grafts.     

四肢组织瓣移植供区继发损伤的处理方法探讨

目的探讨四肢组织瓣移植后供区创面处理的方法,为减少供区并发症提供新思路。方法在进行组织瓣移植的36例中,采用不同的处理方法来减轻或修复供区继发损伤。其中3例(足母)趾甲皮瓣和2例足背皮瓣创面采用次要部位的游离皮瓣修复;5例股前外侧皮瓣供区创面采用同侧腹股沟皮瓣逆转修复;3例(足母)趾腓侧皮瓣供区采用第一跖背动脉皮瓣逆转修复;3例足背皮瓣复合第二趾移植供区采用外踝上皮瓣逆转修复;7例肌瓣和筋膜瓣移至受区后表面植皮,供区直接缝合;13例皮神经营养血管皮瓣分离血管蒂时,保留皮神经在原位。结果所有治疗原发和继发损伤的移植皮瓣均成活,应用带蒂或游离肌瓣、筋膜瓣加表面植皮者,3例植皮完全成活,4例植皮大部成活,皮神经营养血管皮瓣供区及其以远感觉接近正常。结论四肢组织瓣移植后供区继发损伤的处理值得重视,在治疗原发损伤的同时,采用各种方法修复或减少供区损伤,是降低供区并发症的重要措施。     

吻合血管组织移植在创伤与修复外科的临床应用

目的：探讨吻合血管组织移植在创伤与修复外科临床应用经验。方法：1986年以来行吻合血管组织移植127例，其中各种皮瓣或肌皮瓣60例，骨皮瓣移植6例，骨或半关节移植15例，足趾移植拇手指再造35例41指，趾甲皮瓣修复拇，指末节6例，趾关节移植修复指间关节2例，空肠或结肠移植重建咽食道3例。结果：2例皮瓣坏死，余均成活，效果良好。结论：以皮支血管为蒂的皮瓣移植、肌腱穿皮瓣组合移植，血管的端－侧或端－残支吻合、指－趾或跖血管吻合的应用使组织移植更为精确。     

Free dermal fat flaps to the face

Patients with extensive facial asymmetry continue to be a challenge in reconstructive surgery. Surgical techniques using microvascular anastomoses and free flap transfers can now be applied in the management of patients with such conditions as Romberg disease, postirradiation hypoplasia of the face, and Goldenhar syndrome, and in patients with bronchial arch developmental defects. Four patients are presented in this paper to demonstrate the use of free dermal fat in reconstruction of facial asymmetry. One patient with a moderate facial defect was treated with a free dermal fat graft, and the other 3, who had more extensive defects, were treated with deepithelialized free dermal fat flaps using direct microvascular anastomoses between the donor and recipient vessels. The groin was the donor area in each case. Results appear to indicate that free dermal fat flaps are useful in reconstructive procedures for patients with extensive facial defects.     

Reconstruction of facial burn sequelae utilizing tissue expanders with embodiment injection site: case report

Although highly specialized burn centers have significantly reduced mortality rates following extensive total body surface area burns, survivors are often left with grotesque facial disfigurement. Hypertrophic scars and tissue defects are the most common cause of functional and aesthetic problems in the head and neck region. Plastic surgeons use full-thickness or split-thickness skin grafts, pedicled flaps, free flaps, transplantation of bone or cartilage and tissue expansion. The authors present a case of a patient who suffered from third-degree flame burns to the face. Prior skin grafting procedures left him with severe scar deformity of the face. The patient was treated utilizing multiple tissue expansion. Facial animation has retained and facial integrity has been aesthetically restored and, with the use of make-up, it is near normal in social settings at conversational distances. The tissue expansion technique is advantageous in facial reconstruction because it makes it possible to resurface even wider defects with neighboring skin, similar in colour and texture, and superior to skin obtained elsewhere.     

Neovascularized free fat flaps: an experimental model

Using the concepts of neovascularization and microsurgical free transfer, two types of free fat flaps were developed in a rat model. The technique for construction of the flap was to use either a free fat graft or a pedicle fat flap that were then wrapped around a predetermined vascular bundle, subsequently to neovascularize the enveloping fat tissue. Once adequate neovascularization occurred, these flat flaps could then be harvested on a neopedicle consisting of the enveloped artery and vein. These preparations were later examined for viability, and then freely transferred to the contralateral femoral vessels. After transfer, the flaps were again examined for viability and prepared for histologic examination. Both of these studies revealed that successful neovascularized free fat flaps could be created, employing techniques of neovascularization, and that those created using a pedicle fat flap in the initial stage reliably succeeded in neovascularization and free transfer, in contrast with the less successful free fat graft technique.     

游离复合组织瓣移植修复毁损性创面

目的 了解早期应用游离复合组织瓣修复毁损性创面的安全性与效果. 方法 2005-2009年,笔者单位采用游离皮瓣或复合组织瓣修复123例患者128处毁损性创面.所采用的复合组织瓣类型:背阔肌肌皮瓣58例、股前外侧皮瓣32例、旋肩胛皮瓣21例、足背复合组织瓣6例、拇甲瓣3例、前臂皮瓣3例、侧胸皮瓣1例.另行游离背阔肌肌瓣移植+植皮3例、带腓骨小腿外侧皮瓣移植1例. 结果 10例患者术后1～5 d发生血管危象,经紧急手术后修复6例.皮瓣或复合组织瓣移植成活率为95.3%(122/128).随访3个月～4年,皮瓣外形良好,部分功能得以重建.结论 游离复合组织瓣移植降低了截肢率,能Ⅰ期重建功能、更好地恢复外形、减少手术次数、降低并发症发生率、缩短住院时间、减少治疗费用,是修复较大毁损性软组织损伤的较佳方法 .     

First experiences with simultaneous skeletal and soft tissue reconstruction of noma-related facial defects

Noma victims suffer from a three-dimensional facial soft-tissue loss. Some may also develop complex viscerocranial defects, due to acute osteitis, chronic exposure, or arrested skeletal growth. Reconstruction has mainly focused on soft tissue so far, whereas skeletal restoration was mostly avoided. After successful microvascular soft tissue free flap reconstruction, we now included skeletal restoration and mandibular ankylosis release into the initial step of complex noma surgery. One free rib graft and parascapular flap, one microvascular osteomyocutaneous flap from the subscapular system, and two sequential chimeric free flaps including vascularized bone were used as the initial steps for facial reconstruction. Ankylosis release could spare the temporomandibular joint. Complex noma reconstruction should include skeletal restoration. Avascular bone is acceptable in cases with complete vascularized graft coverage. Microsurgical chimeric flaps are preferable as they can reduce the number and complexity of secondary operations and provide viable, infection-resistant bone supporting facial growth.