BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal c...BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.展开更多
Background Random flap is one kind of the most widely used skin flaps in reconstructive surgery; however, partial necrosis of its distal end remains a significant problem now. The aim of this study was to evaluate the...Background Random flap is one kind of the most widely used skin flaps in reconstructive surgery; however, partial necrosis of its distal end remains a significant problem now. The aim of this study was to evaluate the effect of hypoxia preconditioned bone marrow mesenchymal stem cells （HpBMSCs） transplantation on ultra-long random skin flap survival in rats. Methods Normoxic bone marrow mesenchymal stem cells （nBMSCs） were cultured under normoxia （20% 02） and HpBMSCs under hypoxia （1% 02） for 48 hours before transplantation. Thirty Sprague-Dawley rats were randomly divided into control group, nBMSCs group and HpBMSCs group with each consisting of 10 rats. Survival area of ultra-long random skin flap on the dorsal of rats was measured seven days after flap surgery and cell transplantation. Cell survival in vivo, microvessel density and vascular endothelial growth factor （VEGF） were evaluated by histological examination and enzyme-linked immunosorbent assay. Results Compared with other two groups, flap survival area in HpBMSCs group was significantly larger （P 〈0.05）. Microvessel density in HpBMSCs group （36.20-.8.19） was higher than that in nBMSCs group （30.01-.5.68） and control group （17.60..4.19） （P 〈0.05）. VEGF in HpBMSCs group （（300.05-.50.41） pg/g） was higher than those in nBMSCs group （（240.55_＋33.64） pg/g） and control group （（191.65..32.58） pg/g） （P 〈0.05）. Conclusion HpBMSCs transplantation improves ultra-long random skin flap survival via promoting angiogenesis of more survival cells.展开更多
文摘BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.
基金The study was funded by grants from National Natural Science Foundation of China （No. 30900309, 30772269） and Graduate Independent Innovation Foundation of Shandong University （No. yzc09085）.
文摘Background Random flap is one kind of the most widely used skin flaps in reconstructive surgery; however, partial necrosis of its distal end remains a significant problem now. The aim of this study was to evaluate the effect of hypoxia preconditioned bone marrow mesenchymal stem cells （HpBMSCs） transplantation on ultra-long random skin flap survival in rats. Methods Normoxic bone marrow mesenchymal stem cells （nBMSCs） were cultured under normoxia （20% 02） and HpBMSCs under hypoxia （1% 02） for 48 hours before transplantation. Thirty Sprague-Dawley rats were randomly divided into control group, nBMSCs group and HpBMSCs group with each consisting of 10 rats. Survival area of ultra-long random skin flap on the dorsal of rats was measured seven days after flap surgery and cell transplantation. Cell survival in vivo, microvessel density and vascular endothelial growth factor （VEGF） were evaluated by histological examination and enzyme-linked immunosorbent assay. Results Compared with other two groups, flap survival area in HpBMSCs group was significantly larger （P 〈0.05）. Microvessel density in HpBMSCs group （36.20-.8.19） was higher than that in nBMSCs group （30.01-.5.68） and control group （17.60..4.19） （P 〈0.05）. VEGF in HpBMSCs group （（300.05-.50.41） pg/g） was higher than those in nBMSCs group （（240.55_＋33.64） pg/g） and control group （（191.65..32.58） pg/g） （P 〈0.05）. Conclusion HpBMSCs transplantation improves ultra-long random skin flap survival via promoting angiogenesis of more survival cells.
