Evaluation of donor site function and morbidity of the fasciocutaneous radial forearm flap

OBJECTIVE: To assess the results of the use of the free radial forearm flap in terms of objective morbidity and subjective patient response. STUDY DESIGN: The donor sites were examined from 37 patients who underwent reconstruction with a free fasciocutaneous radial forearm flap in the head and neck after ablative tumor surgery. METHODS: Patients were asked to fill in a written questionnaire. The following additional tests were performed: resting skin temperature of digits I and V, temperature after submersion in iced water, grip and pinch tests, and goniometry. RESULTS: Resting skin temperature was slightly decreased for donor hands 0.69 degrees C (P < .001) and 0.31 degrees C (P = .048) for digits I and V, respectively, but recovery after submersion in iced water showed no differences. The strength tests and goniometry revealed no statistically significant findings between donor and control sides. On the questionnaire, 9 patients (24%) reported slightly impaired function, 14 (38%) could not wear their watch or bracelet, 17 (46%) reported numbness, 5 (14%) reported soreness, 5 (14%) reported itching, 6 (16%) reported cold intolerance, 5 (14%) reported bad cosmetic appearance, and 9 (24%) expressed the opinion that they were insufficiently counseled. CONCLUSION: There is a negligible objective morbidity of a free radial forearm flap harvest procedure, but a number of patients have subjective complaints when asked. Elaborate presurgical counseling can probably reduce these complaints.     

Two-stage treatment with sliding fibular flap technique for chronic infected nonunion of the tibia

Purpose: To assess the effectiveness of two-stage treatment with the fibular sliding technique in chronic infected nonunion of the tibia. Methods: The study included patients who were diagnosed with long-term chronic infected tibial nonunion following trauma and treated with the two-stage technique between January 2010 and November 2017. Patients with (1) intra-articular fractures of the distal third of the tibia and fibula, (2) pathological fracture resulting in bone loss or (3) neurological and vascular pathologies of the limbs were excluded. The operation consisted of two stages and the main goal in the first stage was to control the infection and in the second stage to control the healing of the bone. Functional & radiographic results and complications were evaluated according to Paley''s criteria. Results: The patients comprised 14 males and 5 females with a mean age of 37.4 years (range, 21-52 years). Patients were followed up for an average of 27 months (range, 15-38 months). The microorganisms produced from these patients were Staphylococcus aureus in 13 patients, Pseudomonas aeruginosa in 4 patients and no bacteria in 2 patients. After the first stage operation, superficial skin necrosis developed in 1 patient. In another patient, there was a persistent infection, although union was achieved. For the entire patient group, union was observed at the end of 7.44 months (range, 7-11 months). Based on Paley''s criteria, there were 16 (84.2%) patients with excellent scores, 2 (10.5%) good scores and 1 (5.3%) fair scores radiologically; while regarding the tibial function, 15 (78.9%) patients had excellent scores, 3 (15.8%) good scores, and 1 (5.3%) fair scores. No patients had poor radiological or functional score. Conclusion: Two-stage treatment can be considered as an alternative for fractures in regions that are susceptible to many and persistent complications, such as the tibia. This technique has the advantages of short operation time, minimal blood loss, no excessive tissue damage and not very technique-demanding (a short learning curve with no requirement for an experienced team).     

Reconstruction of distal nasal deficiency using the bilobed flap

Summary Many techniques have been described to repair defects of the distal nose. The author has found the bilobed flap to be a useful technique in the repair of partial thickness and full thickness defects. Good cosmetic results can be achieved. Several examples are described.     

Prostacyclin formation in undelayed and delayed pig flank flaps

Summary A specific 6-keto-prostaglandin PGI₂ radioimmunoassay (R.I.A.) was used to follow tissue prostacyclin formation in a series of acute and delayed pig flaps. Each flap measured 12×5 cm and four white, female ehester pigs, averaging 21 kgs in weight, were used. Flap tissue samples were taken at day 0 (control) 1–8, 10, 14, 17 and 21 using 0.4 mm diameter cork borer. Prostacyclin formation started to rise on day 4 and extended until the 10th day in both types of flaps. The hyperemic circulation that occurred following delay procedure is associated with a rise in prostacyclin production whereas the higher rise in prostacyclin in the undelayed flap is due to the reactive inflammation.     

Subventricular zone-derived neuronal progenitors migrate into the subcortical forebrain of postnatal mice

The presence of a germinal layer and the capacity to generate neurons, once thought restricted to the embryonic brain, persists in the forebrain of both postnatal and adult mammals. The two regions in which this phenomenon has been extensively demonstrated are the hippocampal dentate gyrus and the lateral ventricle subventricular zone (SVZ). SVZ-derived cells migrate along the rostral migratory stream into the olfactory bulb, where they differentiate into local interneurons. In this study, using tracer injections into the SVZ at different postnatal ages, we investigated the occurrence of secondary migratory pathways in the mouse subcortical forebrain. During the course of the first week postnatal, in addition to the well-characterized rostral migratory stream, SVZ-derived progenitors migrate in a ventral migratory mass across the nucleus accumbens into the basal forebrain and along a ventrocaudal migratory stream originating at the elbow between the vertical and horizontal limbs of the rostral migratory stream. These cells give rise to granule neurons in the Islands of Calleja and olfactory tubercle pyramidal layer, respectively. In adult, a very small number of cells continue to migrate along the ventrocaudal migratory stream, whereas no migration was observed across the nucleus accumbens. These data demonstrate that in early postnatal and, to a minor extent in adult mice, SVZ-derived cells contribute new neurons to the subcortical forebrain.     

Multiple spurting test in microsurgical reconstruction of the lower extremities

Appropriate recipient artery is essential for the success of free flap reconstruction, however the selection could be difficult in a traumatized lower extremity. To detect unnoticed damage of the recipient artery, vascular integrity should be verified. For that purpose, we propose a simple and effective evaluation method, called Multiple Spurting Test (MST) this test esteems the dynamic status of the recipient arteries by measuring the length of arterial spurting. All the microsurgeons usually do something like MST: but it is not a standardized test yet.     

斜方肌骨肌皮瓣在修复半侧下颌骨切除及口腔软组织缺损中的应用

目的：评价斜方肌骨肌皮瓣修复口腔软组织和半侧下颌骨切除术后缺损的可靠性。方法：10例口腔、颌骨恶性肿瘤患者行半侧下颌骨和累及的软组织手术切除,术后缺损采用斜方肌骨肌皮瓣修复。男6例,女4例,年龄45～79岁,平均年龄61．2岁。T4N0M0期3例,T4N1M0期7例。皮瓣大小为（7cm×6cm）～（16cm×8cm）。结果：8例患者皮瓣全部成活。2例患者皮瓣边缘略有坏死。随访观察7～24个月,7例患者生存良好,无复发;1例患者死于肝、肺转移;2例患者术后复发,行二次手术,目前尚存活。结论：斜方肌骨肌皮瓣是一种修复口腔软组织和下颌骨半侧切除遗留的巨大缺损可靠的方法。     

DNA甲基化与结肠癌

DNA异常甲基化是肿瘤常见的表观遗传学改变.广泛的低甲基化和区域性高甲基化是基因异常表达的常见机制.某些基因异常甲基化与结肠癌发生密切相关,且常见于结肠癌发病早期.     

游离腓骨瓣行颌骨修复重建后下肢功能评价及护理对策

目的评价游离腓骨瓣行上、下颌骨修复重建后患者下肢的功能,分析并提出相应的护理对策。方法41例游离腓骨瓣行上、下颌骨修复重建的患者．分别于手术前、术后2周、术后3个月、术后6个月进行客观测量和运用Enneking下肢功能量表行主观评价。结果41例患者术后2周下肢均有肿胀,术后3个月33例下肢有肿胀,术后6个月7例下肢有肿胀;术后6个月时患者踝关节内翻、外翻、跖屈受限,躅指肌力和蹰指抗阻力量基本恢复;主观评价方面,肢体疼痛、自我感受、行走能力和步态改变在术后6个月时基本恢复,支具使用术后3个月时恢复,总分和功能活动评分随时间变化而增高,但明显低于术前得分。结论游离腓骨瓣对患侧下肢功能手术后短期内存在影响,应加强对供区的术后康复训练。     

掌背皮神经营养血管蒂岛状皮瓣修复手指软组织缺损

目的总结分析用掌背皮神经营养血管蒂逆行岛状皮瓣修复手指软组织缺损的疗效。方法2005年6月至2008年5月应用掌背皮神经营养血管蒂逆行岛状皮瓣治疗手指软组织缺损30例,其中男21例,女9例;30例中拇指末节缺损6例,拇指指背缺损4例,食指指腹缺损5例,中指指腹缺损3例,示、中指指背软组织缺损各5例,环指指背软组织缺损2例。急诊手术27例,择期手术3例。皮瓣最大面积5．0cm×3．5cm,最小面积3．0cm×2．5cm。结果28例皮瓣成活良好,2例皮瓣术后2～3d出现暗紫、肿胀、结痂,经对症处理脱痂后成活;经5～12个月随访,手指外形和功能恢复满意。结论掌背皮神经营养血管蒂逆行岛状皮瓣血供可靠,不损伤知名血管,操作简单,是修复手指软组织缺损较理想的皮瓣。