低温冷冻同种异体胎软骨移植的应用

目的探讨同种异体胎软骨在整形外科应用的可行性。方法在无菌条件下切取死胎儿的四肢及肋软骨,经低温保护剂进行超低温冷冻－８０℃,保存于－１９６℃的液氮中。经复温处理后应用于临床３８例。其中鞍鼻畸形２４例,外耳缺损４例,唇裂继发畸形６例,颏成形４例。结果经３年６个月随访。除２例外耳再造术后出现变形外,其余病例均无吸收、变形、免疫排斥反应,外形较为满意。结论同种异体胎儿软骨在整形外科有一定的应用价值。     

低温冷冻同种异体胎软骨移植的应用

目的探讨同种异体胎软骨在整形外科应用的可行性。方法在无菌条件下切取死胎儿的四肢及肋软骨,经低温保护剂进行超低温冷冻-80℃,保存于-196℃的液氮中。经复温处理后应用于临床38例。其中鞍鼻畸形24例,外耳缺损4例,唇裂继发畸形6例,颏成形4例。结果经3年6个月随访。除2例外耳再造术后出现变形外,其余病例均无吸收、变形、免疫排斥反应,外形较为满意。结论同种异体胎儿软骨在整形外科有一定的应用价值。     

低温冷冻同种异体胎软骨移植在整形外科的应用

在无菌条件下切取计划外生育引产胎儿的四肢及胸肋部软骨，应用于临床３８例。将切取的软骨经１５％的二甲基亚砜（ＤＭＳＯ）为低温保护剂。放入低温冰箱内以０．５～１．０／ｍｉｎ速度降温到－８０℃时保持３０分钟，保存于－１９６℃的液氮中。用于鞍鼻畸形２４例，外耳缺损修复４例，唇裂继发畸形修复６例，下颌成形４例。随访最长３年，最短６个月，除２例外耳再造术后出现变形外，其余病例均无吸收、变形、排异反应，外形较为满意。重点对胎儿软骨的切取、冷冻处理、软骨的保存、临床排异现象进行了浅淡，并认为同种异体胎儿软骨移植用于临床具有一定的应用价值，因胎儿软骨来源广泛，切取容易，经冷冻后保存时间较长等优越性     

速冻同种异体骨临床应用

我院自１９８６年起用速冻法处理同种异体骨并用以临床３０例，效果满意，报告如下。临床资料１．一般情况：本组３０例中男２２例，女８例；年龄１０～３６岁；肱骨１２例，股骨１０例，胫骨６例，指骨１例，跟骨１例；骨折１３例，骨肿瘤及瘤样病损１０例，畸形３例，其它骨病４例。２．同种异体骨处理及保存方法：无菌取出健康人外伤性截肢及外伤性死亡患者的骨后，剔除骨膜、软骨及骨髓，无菌生理盐水冲洗。根据需要截成整块或碎条状，双层无菌单包裹后立即置－７０℃～－８０℃环境下速冻１～２小时，取出后常温下浸入９５％的酒精内１…     

双侧先天性小耳畸形的耳廓再造术

目的：探讨双侧先天性小耳畸形的外耳再造手术治疗方法。方法：2007年3月～2008年6月对21例双侧先天性小耳畸形采用耳后皮肤扩张结合自体肋软骨支架植入,耳后筋膜瓣掀起,中厚植皮术双侧同期进行外耳再造。结果：经6个月-1年的随访观察,21例中除2例再造耳有不同程度的软骨吸收、变形外,其余再造耳的大小、形状、位置与面部协调,双侧对称,再造耳外形逼真,微细结构显示清晰。结论：对于双侧先天性小耳畸形,同期应用耳后皮肤扩张结合自体肋软骨支架植入,耳后筋膜瓣掀起,中厚植皮术进行外耳再造,方案可行,效果满意,是双侧先天性小耳畸形理想的外耳再造手术治疗方法。     

应用异体耳软骨支架行全耳再造八例

我们报告了８例应用异体耳软骨支架行全耳再造术的经验。异体耳软骨支架外形自然逼真，不需雕刻加工。经戊二醛处理埋植皮下后，短期内即与周围组织紧密粘连。经６个月到２年的随访观察效果良好，未发生临床排斥反应和吸收变形等并发症。     

人工关节假体复合大段同种异体骨移植重建肢体功能

目的 探讨采用复合人工关节假体大段同种异体骨移植的方法治疗肢体恶性骨肿瘤的手术原理及效果。方法 骨肿瘤患者１６例,年龄１９岁－６０岁,其中骨肉瘤４例,软骨肉瘤２例,恶性骨巨细胞瘤３例,纤维肉瘤３例,其它恶性骨肿瘤４例,肢体功能重建方法包括：复合股骨近端的全髋关节置换术３例,复合股骨近端的双极人工股骨头置换术７例,复合股骨下端或胫骨上端的全膝关节置换６例,结果 本组１６例经１．５－５．０年随访,１例     

三种耳廓支架材料再造耳

耳廓再造术要用耳廓支架对再造耳进行支撑。１９８４年～１９９６年，对收治的３３例耳廓缺如畸形患者，采用自体肋软骨雕刻支架、同种异体耳软骨支架及硅胶管钢丝支架等三种不同的支架，切取经埋置皮肤软组织扩张器进行预扩张后的耳后皮瓣，包裹支架材料，行全耳再造或修复，２２例经平均３年６个月随访，患者满意或基本满意者１６例，不满意３例，手术失败３例。认为，全耳廓再造以自体肋软骨材料为支架效果较好，以同种异体肋软骨或硅胶管钢丝作支架应慎重选择。     

皮管法外耳缺损畸形修复的探讨

外耳由于其形态复杂皮肤薄而皮下组织少,且皮肤与薄而有弹性的软骨相连,因而外耳缺损畸形的修复是整形外科长期以来探讨的问题之一,其方法主要为耳后或耳前的局部皮瓣,远位皮瓣即皮管法以及植皮等。     

深低温冷冻同种异体骨修复骨缺损的临床应用

采用－８０℃深低温冷冻同种异体骨植骨治疗缺损３２例。四肢良性肿瘤１７例，恶性肿瘤２例，创伤性骨缺损６例，重建椎体６例，重建跟重１例，异体骨加自体骨移植１８例，单纯异体骨１４例，大块异体骨移植１４例。Ｘ线片显示移植骨与宿主骨愈合良好，认为深低温冷冻同种异体骨是一种较理想的骨缺损修复材料。     

Autologe Rekonstruktion schwerer Fehlbildungen und Defekte der Ohrmuschel

The construction of an auricle using autologous material is undoubtedly one of the most demanding tasks in facial plastic surgery. Considered practically impossible only a few decades ago, today we are able to achieve reproducible, natural-looking and long-term stable surgical results. The cornerstone of ear reconstruction is the use of costal cartilage to reconstruct or replace the ear’s deficient cartilage structure. The subtle dissection and reconstruction of the ear’s skin and soft tissue is also of great importance. This aspect is multifaceted and subsumes all plastic surgical techniques including free flaps. In this paper, we wish to provide an overview of our strategies for the correction of microtia and the reconstruction of severe external ear deformities.     

Brachial plexus birth palsy-associated shoulder deformity: a rat model study

PURPOSE: Although recovery occurs in the majority of cases of brachial plexus birth palsy (BPBP), long-term shoulder disability is relatively common. The aim of this study was to establish an animal model to study BPBP-associated shoulder deformities. METHODS: A right-side C5, C6 root neurotomy was performed under the surgical microscope in 5-day-old Sprague-Dawley rats (N = 9). The contralateral side served as a control. The development of shoulder deformity and range of motion loss were followed longitudinally. Animals were killed 4 months after surgery. Both shoulders were harvested, decalcified, and transected in the axial plane for glenoid version measurement and shoulder histology. RESULTS: All animals developed shoulder internal rotation contracture within 4 weeks after the C5, C6 neurotomy. The average shoulder external rotation loss was 52 degrees +/- 7, 59 degrees +/- 10, and 82 degrees +/- 11 in comparison with the control side 1, 2, and 4 months after neurotomy, respectively. Glenoid version changed from 2 degrees +/- 2 of retroversion (left side) to 8 degrees +/- 3 of anteversion. Five shoulders were subluxated clinically with a pseudoglenoid formation observed radiographically. Histologic study demonstrated marked glenoid and humeral head deformities. CONCLUSIONS: This neonatal rat model clearly demonstrated typical shoulder deformities similar to that resulting from Erb's palsy. This model can be useful in studying BPBP-associated shoulder deformities.     

The incision-excision technique in minor auricular deformities

In 1972, in the search for a method to cope with all deformities in protruding ears and other common minor auricular deformities, Claus Walter published a surgical technique based on various incisions and excisions of the cartilage. The procedure consists of a complete separation of the auricle into two parts, combined with remodeling of antihelical, helical, and lobular structures without use of adjusting sutures. Thus, even in patients with stiff and unyielding cartilage and in revisional surgery, pleasing aesthetic results may be achieved. The recurrence rate has found to be reduced markedly. Considering all pros and cons and optional surgical modifications, the incision-excision technique can be adopted for every protruding ear as well as for lop ears, moderate cup ear deformities, and secondary revisions. Because of the extent of cartilage dissection, this technique is not recommended for beginners but should be restricted to experienced surgeons with profound knowledge of basic remodeling procedures.     

皮肤扩张及自体肋软骨支架法全耳廓成形术矫正先天性小耳畸形

目的探讨耳后乳突区皮肤扩张及自体肋软骨支架法全耳廓成形术矫正先天性小耳畸形的临床效果。方法21例先天性小耳畸形患者,分3期进行手术治疗。Ⅰ期：患侧耳后乳突区皮下埋置50ml肾形扩张器,术后定期注水,扩张皮肤3～4个月,平均注水（80．51±3．87）ml,达预定量后稳定养护1个月。Ⅱ期：取自体肋软骨,雕刻成由4层软骨构成的耳支架,整体为倒立的海螺样外观,将扩张皮瓣覆盖于整个自体肋软骨支架表面,再造耳廓。Ⅲ期：Ⅱ期术后3个月对成形耳进行细节性修整。结果21例患者手术均获成功,成形耳廓大小、外形均与健侧相似,医患双方满意。结论耳后乳突区皮肤扩张法所扩张的皮肤,可覆盖于整个自体肋软骨支架表面,术后耳廓外形逼真,立体感强。     

Microtia repair with rib cartilage grafts: a review of personal experience with 1000 cases

Surgical construction of the auricle with autogenous tissues is a unique marrying of science and art. Although the surgeon's facility with both sculpture and design is imperative, the surgical result is equally influenced by adherence to sound principles of plastic surgery and tissue transfer. The material reviewed in this article is derived from clinical experience with congenital microtia: 1094 completed ears in 1000 patients (94 cases were bilateral). This article focuses on total repair of major congenital ear defects, but includes relevant supplementary input from experience gained by managing more than 125 traumatic auricular deformities.     

Simultaneous open-heart surgery and pectus deformity correction

PURPOSE: Pectus deformities and cardiac problems sometimes require simultaneous surgery. We report our experience of performing this surgery and review the relevant literature. METHODS: We performed simultaneous pectus deformity correction and open-heart surgery in six patients between 1999 and 2006. The pectus deformities were pectus carinatum in one patient and pectus excavatum in five patients. The cardiac problems were coronary artery disease in one patient, an atrioseptal defect (ASD) with a ventricular septal defect (VSD) in one, a VSD in one, mitral valve insufficiency with left atrial dilatation in one, and an ascending aortic aneurysm with aortic valve insufficiency caused by Marfan's syndrome in two. We corrected the pectus deformities using the modified Ravitch's sternoplasty in all patients. First, while the patient was supine, we resected the costal cartilage; then, after completing the cardiac surgery, the sternum was closed and the additional time required for the pectus operation was calculated for each patient. Patients were examined 1, 4, and 6 months postoperatively. RESULTS: The average operation time was 102 min, and there were no major complications. The pectus bars were removed 4-6 months postoperatively. Good cardiac and cosmetic results were achieved in all patients, who were followed up for 5 years. CONCLUSIONS: Concomitant pectus deformity correction and open-heart surgery can be performed safely, eliminating the risks of a second operation in a staged procedure.     

Shaping of nasal septal cartilage with the carbon dioxide laser—a preliminary report of an experimental study

Pieces of cartilage 0.5–1 mm thick taken from patients undergoing nasal septal surgery and from the nasal septum and auricle of the rabbit were irradiated using a carbon dioxide laser at 10.6 μm wavelength and a spot size of 1–2 mm. The laser was used both in the pulsed and the continuous wave (cw) mode. In the pulsed mode the pulse length varied from 0.05 to 0.5 s with an average power output of between 1 and 5 W. In cw mode the power varied between 1 and 6 W. It was possible to use the laser energy to mould the cartilage into different shapes which were then maintained after irradiation. These observations have not previously been reported. The clinical significance of this experiment for plastic surgery in the head and neck is discussed.     

Temperature dependent change in equilibrium elastic modulus after thermally induced stress relaxation in porcine septal cartilage

BACKGROUND AND OBJECTIVES: Laser cartilage reshaping (LCR) is a promising method for the in situ treatment of structural deformities in the nasal septum, external ear and trachea. Laser heating leads to changes in cartilage mechanical properties and produces relaxation of internal stress allowing formation of a new stable shape. While some animal and preliminary human studies have demonstrated clinical feasibility of LCR, application of the method outside specialized centers requires a better understanding of the evolution of cartilage mechanical properties with temperature. The purpose of this study was to (1) develop a method for reliable evaluation of mechanical changes in the porcine septal cartilage undergoing stress relaxation during laser heating and (2) model the mechanical changes in cartilage at steady state following laser heating. STUDY DESIGN/MATERIALS AND METHODS: Rectangular cartilage specimens harvested from porcine septum were heated uniformly by a radio-frequency (RF) electric field (500 kHz) for 8 and 12 seconds to maximum temperatures from 50 to 90 degrees C. Cylindrical samples were fashioned from the heated specimens and their equilibrium elastic modulus was measured in a step unconfined compression experiment. Functional dependencies of the elastic modulus and maximum temperature were interpolated from the measurements. Profiles of the elastic modulus produced after 8 and 12 seconds of laser irradiation (Nd:YAG, lambda = 1.34 microm, spot diameter 4.8 mm, laser power 8 W) were calculated from interpolation functions and surface temperature histories measured with a thermal camera. The calculated elastic modulus profiles were incorporated into a numerical model of uniaxial unconfined compression of laser irradiated cylindrical samples. The reaction force to a 0.1 compressive strain was calculated and compared with the reaction force obtained in analogous mechanical measurements experiment. RESULTS: RF heating of rectangular cartilage sample produces a spatially uniform temperature field (temperature variations < or = 4 degrees C) in a central region of the sample which is also large enough for reliable mechanical testing. Output power adjustment of the RF generator allows production of temperature histories that are very similar to those produced by laser heating at temperatures above 60 degrees C. This allows creation of RF cartilage samples with mechanical properties similar to laser irradiated cartilage, however with a spatially uniform temperature field. Cartilage equilibrium elastic modulus as a function of peak temperature were obtained from the mechanical testing of RF heated samples. In the temperature interval from 60 to 80 degrees C, the equilibrium modulus decreased from 0.08+/- 0.01 MPa to 0.016+/-0.007 MPa, respectively. The results of the numerical simulation of uniaxial compression of laser heated samples demonstrate good correlation with experimentally obtained reaction force. CONCLUSIONS: The thermal history and corresponding thermally induced modification of mechanical properties of laser irradiated septal cartilage can be mimicked by heating tissue samples with RF electric current with the added advantage of a uniform temperature profile. The spatial distribution of the mechanical properties obtained in septal cartilage after laser irradiation could be computed from mechanical testing of RF heated samples and used for numerical simulation of LCR procedure. Generalization of this methodology to incorporate orthogonal mechanical properties may aid in optimizing clinical laser cartilage reshaping procedures.     

改良猪耳郭软骨细胞体外培养的实验研究

目的：为组织工程化软骨修复机体软骨缺损提供实验基础。方法：用消化组织块培养法体外培养猪耳郭软骨细胞,并观察其在Polyglycolicacid（简称PGA）支架上的生长情况。结果：软骨细胞在pH值为7.0,含10%胎牛血清的DMEM培养液中生长良好,可传代10代,细胞数目扩增为原来的400～500倍;软骨细胞在PGA支架上生长良好,分泌基质旺盛。结论：改良消化组织块方法培养软骨细胞是一种可以大量扩增软骨细胞数目的确实可行的方法,PGA是软骨细胞良好的生长支架。