深低温冻存同种异体皮肤移植中转化生长因子β1的表达

背景:皮肤移植和创面覆盖是创伤、烧伤治疗的重要措施。目前,同种异体皮仍然是可利用的最佳创面覆盖物。目的:通过检测转化生长因子β1在深低温冻存后的大鼠同种异体皮肤移植后的表达,评估深低温贮存同种异体皮在创面上的应用。方法:取大鼠皮肤保存于低温-20℃(低温保存组)及-80℃深低温(深低温保存组),冻存1周、1,2个月后,皮片分组移植于同种大鼠背部进行实验,并以自体移植大鼠作为对照组。结果与结论:同低温保存组相比,深低温保存组转化生长因子β1的表达被抑制,移植皮肤排斥反应出现时间延迟及存活时间延长,排斥反应评分也较低。同低温冻存相比,深低温冷冻保存能使同种异体移植物的转化生长因子β1抗原表达降低。提示深低温冻存的异体皮作为一种创面临时覆盖物,在存在皮肤组织缺失或皮源不足的情况下具有广阔的应用前景。

侧移皮肤/黏膜瓣术治疗瘘管性肛周脓肿15例临床疗效观察

目的观察行侧移皮肤/黏膜瓣术在治疗瘘管性肛周脓肿的临床疗效。方法纳入2015年4月至2015年9月,江苏省中医院收治的30例瘘管性肛周脓肿患者,其中治疗组15例行侧移皮肤/黏膜瓣术,对照组15例行一次性切开挂线引流术治疗,比较治疗效果。结果两组总体有效率差异无统计学意义(P>0.05)。但与对照组对比,治疗组创面愈合时间明显缩短,差异有统计学意义(P<0.05),治疗组愈合时间(23.33±3.52)天,对照组愈合时间(26.20±3.91)d。治疗组的术后疼痛感、尿潴留和肛门漏气、漏液、漏固体等均有改善,差异有统计学意义(P<0.05)。结论侧移皮肤/黏膜瓣术治疗瘘管性肛周脓肿,是一种值得在临床上推广的术式。

交腿皮瓣修复小腿软组织缺损术后患者翻身的舒适护理

目的:探讨交腿皮瓣修复小腿软组织缺损术后患者翻身的舒适护理。方法:对17例交腿皮瓣修复小腿软组织缺损术后患者翻身时进行心理疏导、舒适体位的摆放、减轻疼痛等舒适护理。结果:17例患者无一例发生护理并发症,在翻身过程中患者均感舒适,患者对护理工作满意率达100%。结论:在交腿皮瓣修复小腿软组织缺损术后患者翻身中应用舒适护理,有利于促进患者康复,提高了护理质量。

THE EFFECT OF SKIN GRAFTING AT DIFFERENT TIME POST BLOOD TRANSFUSION AND BONE MARROW TRANSPLANTATION ON RATS COMBINED RADIATION-BURN INJURY

After the rats were inflicted with 8 Gy total body gamma ray irradiation and 15 % total body surface area (TBSA) full thickness burn injury, they were treated with blood transfusion (BT) and bone marrow transplantation (BMT). Then the survival of allografts grafted on the escharectomized burn wounds in the 24, 48 and 72 h postinjury was observed. It was found that when the burn wounds were closed with allo- grafts in the 24h postinjury, there were an early elevation of leucocytes, the appearance of the donor’s cells and a significantly higher survival rate of the rats on the 30 day postinjury. The allografts could survive longer and wounds showed no signs of infection and healed quicker. When the allografts were grafted in the 48 h or 72 h postinjury, only harmful effects to hasten the death of rats were observed.

Needle track seeding:A real hazard after percutaneous radiofrequency ablation for colorectal liver metastasis

Neoplastic needle track seeding following percutaneous radiofrequency ablation(RFA)of secondary liver tumors is exceedingly rare.Reports on cutaneous tumor seeding after percutaneous RFA for colorectal liver metastasis are even rarer in the literature.Here we report a case of a 46-year-old female who developed an ulcerating skin lesion along the needle track of a previous percutaneous RFA site around 6 mo after the procedure.The previous RFA was performed by the LeVeen needle for a secondary liver tumor from a primary rectal cancer.The diagnosis of secondary skin metastasis was confirmed by fine needle aspiration cytology.The lesion was successfully treated with wide local excision.We believe that tumor seeding after percutaneous RFA in our patient was possibly related to its unfavorable subcapsular location and the use of an expansion-type needle.Hence,prophylactic ablation of the needle track should be performed whenever possible.Otherwise,alternative routes of tumor ablation such as laparoscopic or open RFA should be considered.

Kanglaite combined Gemcitabine inhibits growth of nude mouse subcutaneous transplantation tumor of human PC-3 pancreatic cancer cell

Objective:To study the mechanisms of pancreatic cancer treatment with Kanglaite combined Gemcitabine by investigating the relationship between the apoptosis and the expression of bcl-2, Bax and VEGF in pancreatic cancer cells.Methods:Nude mouse subcutaneous transplantation tumor model of Human PC-3 pancreatic cancer was established; the expressions of bcl-2, Bax and VEGF of transplantation tumor cell were determined; the earlier apoptosis rate of pancreatic cancer cell and the gross tumor volume were determined. Results:Kanglaite combined Gemcitabine remarkably decreased the protein expression of bcl-2,raised the expression of Bax,increased the apoptosis rate of the pancreatic cancer and contract the gross tumor volume. Kanglaite greatly decreased the protein expression of VEGF of the tumor cell. Conclusion:Therapeutic efficacy of Kanglaite combined Gemcitabine is far better than separate use of the two medicines in the pancreatic cancer transplantation tumor treatment.

Clinical trial of three treatment methods for pterygium

Objective:To study the effect of simple excision, amniotic membrane transplantation(AMT)and limbal-conjunctival autograft transplantation(LCAT)for treating pterygium. Methods: Forty-eight cases (48 eyes) with pterygium were randomly assigned to 3 groups:16 cases (16 eyes) with pterygium underwent simple excision (group A), 16 eyes underwent amniotic membrane transplantation (AMT) (group B), and 16 eyes with pterygia underwent limbal- conjunctival transplantation (group C).Results: With follow-up of 3 months to 25 months, 5 cases (31%) of pterygia in group A and 1 case (6.2%) of pterygia in group B showed recurrence. No patients in group C developed recurrence. Conclusion: The recurrent rate of pterygium after amniotic membrane transplantation and limbal-conjunctival autograft transplantation were much lower, but the latter was more simple, safe and no rejection .So limbal - conjunctival autograft transplantation is the best surgery method for pterygium.

Meek微型皮片移植技术在大面积深度烧伤中的应用

目的应用Meek微型皮片移植术修复大面积深度烧伤创面，观察和评价其临床疗效。方法使用国外引进的Meek植皮机，以1：4或1：6双褶薄纱快速扩展移植皮片，与分别采用的邮票状皮移植、微粒皮植皮技术修复创面对手术时间、术后皮片成活率、供／受皮区愈合等情况进行比较观察。结果应用Meek植皮技术的手术时间明显缩短，移植皮片成活率高、愈后外观良好，供皮区愈合快，受皮区愈合质量满意。结论Meek植皮技术作为新型的微型皮片移植技术，对于大面积深度烧伤的治疗，具有较大的优越性和临床应用价值。

Effect of externally applied Jidesheng anti-venom on skin and soft-tissue necrosis after Chinese cobra bite: a retrospective study

OBJECTIVE: To evaluate the effects of Jidesheng anti-venom used externally for skin and soft-tissue necrosis from Chinese cobra bite.METHODS: A retrospective review was performed according to the clinical data recorded from January 2002 to December 2012. A total of 126 patients(116 females and 10 males) with skin and soft-tissue necrosis due to Chinese cobra bite were divided into two groups. The control group was treated externally with 40% glyceride magnesium sulfate(n=52), and the treatment group was given Jidesheng anti-venom externally(n=74). The data collected included maximum local necrotic area of skin and soft tissues, de-tumescence time, healing time,and skin-grafting rate.RESULTS: There were no significant differences in gender, age, and disease condition between the control and treatment groups(P>0.05). No statistically significant difference was found in de-tumescence time between the two groups(P>0.05). The maximum local necrotic area of skin and soft tissues was(19.9 ± 7.3) cm2in the treatment group,while it was(23.3±6.4) cm2in the control group.The healing time of the treatment group was shorter than that of the control group [(32.1 ± 3.7) vs(34.4±4.5) days)] The skin-grafting rate in the treatment group was lower than that of the control group(10.81% vs 25.00%). There were statistically significant differences in maximum local necrotic area of skin and soft tissues, healing time, and skin-grafting rate between the control and treatment groups(all P<0.05).CONCLUSION: External application of Jidesheng anti-venom may help to promote wound healing and reduce the skin-grafting rate in cases of skin and soft-tissue necrosis due to Chinese cobra bite.

Treatment of type III middle phalangeal neck fractures through a palmar approach： a case report

Phalangeal neck fractures occur almost exclusively in children. We present the case of a 49 years old man with a dislocated fracture of the neck of the middle phalanx with the distal fragment rotated at 180~, due to a traumatic circular saw injury to the left index, which was solved by anatomical reduction and bone fixation with two 1.5 mm Synthes screws and a temporary transarticular K- wire at the distal interphalangeal joint. Zone I flexor digitorum profundus repair was performed using a modification of the Kessler 4-strands core suture and a full-thickness skin graft from the hypothenar eminence was taken to cover the skin gap. At 6-month follow-up the patient was pain-free and with a total active movement equivalent to 190~. No radio-logical signs of avascular necrosis of the head of the middle phalanx or nonunion of the distal fragment was detectable with recovery to the previous manual work. Owing to the position of the phalangeal head maintained in position by the collateral ligaments an anatomic reduction from dorsal approach is difficult to be performed and a longitudinal trac- tion can render the reduction harder too. The volar approach permits an easier reduction of the fracture through a derotation of the distal fragment facing palmar.

Dynamic changes of interleukin-1, interleukin-6 and tumor necrosis factor in intermingled skin graft in burned rats

To compare the dynamic changes of interleukin 1 (IL 1), interleukin 6 (IL 6), and tumor necrosis factor (TNF) in intermingled skin graft with those in other types of skin grafts in rats. Methods: A 10% 15% third degree burn was created in 180 Spregue Dawley (SD) rats. After removing the scar, skin grafts were performed on the open wounds immediately with autoskin (aus, n=54), alloskin (als, n=54) and intermingled skin (n=36). That is to say, in the intermingled skin graft, a big piece of alloskin (mals) was grafted first, and 3 days later, small pieces of autoskin (maus) were embedded in the alloskin. The rest 36 rats were taken as the controls. And the biological activities of IL 1, IL 6 and TNF in graft sheets in each group were detected after skin graft. Results: The levels of IL 1, IL 6 and TNF in the aus group decreased steadily after their initial elevations, whereas in the als group they increased significantly and kept on the peak level in the later phases. In the intermingled group, there appeared a lowest IL 1 level in the mals and a highest one in the maus simultaneously at 7 (4) days (The number out of parenthesis is the days after transplanting with alloskin sheets, and the number in parenthesis is the days after embedding autoskin sheets in the intermingled skin graft. Similarly hereinafter.) after skin graft (P< 0.01 ), and the high level in the maus abruptly decreased at 14 (11) days after skin graft. At exactly the same phase on day 7 (4), a prominent peaked IL 6 in the mals occurred. In the later phases, the levels of TNF remained relatively low both in the mals and in the maus. From day 7 (4) on, each cytokine fluctuation in the mals synchronized with that in the maus. The longer the post transplantation period lasted, the more the positive cytokine correlated between the mals and the maus. Conclusions: The low levels of IL 1 and TNF may be important factors to lighten the intensity of local rejection in the intermingled skin graft. The temporarily peaked IL 6 is both an inducer which induces the production of local IL 1 receptor antagonists and soluble TNF receptors and a signal which indicates a local enhancement of Th 2 cells. The mild rejection process and the synchronized cytokine level during the later phases suggest a possible chimerism between the mals and the maus.

Treatment of degloving injury of three fingers with an anterolateral thigh flap

The degloving injuries of the digits and palm remain a persistent challenge. We used an anterolateral thigh flap to treat an 18-year-old, right-handed male worker with degloving injuries of the index, middle and ring fingers. The flap was designated to wrap the entire circumference of three fingers sustaining degloving injury and to form mitten-hand. The total lengths of the distal phalanxes of three fingers were retained almost complete. The donor defect was covered with split-thickness skin graft. Three months after the first operation, roentgenograms revealed terminal phalanxex resorption in three injured fingers, and the surgical syndactyly between the middle and ring finger was separated at the same time. One month later, the syndactyly between the index and middle fingers was also separated. Good coverage of the soft tissue defects with good function and appearance was achieved. Therefore, we considered that the length of the degloved finger could be preserved using free flap.

Use of pedicled latissimus dorsi myocutaneous flap to reconstruct the upper limb with large soft tissue defects

[Abstract] Objective： To report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocu- taneous flaps. Methods： Six patients with large skin and soft tissue defects were included in this report. There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar. All wounds were in the upper extremity. The sizes of defects ranged from 15 cmx6 cm to 30 cmx 18 cm. Pedicled latissimus dorsi myocutaneous flaps were designed according to the defect area and raised with part of latissi- mus dorsi. The thoracodorsal artery and its perforators were carefully protected during surgery. Results： All flaps healed primarily without flap congestion, margin necrosis or infection. The skin donor sites either received split-thickness skin graft （3 cases, mostly from the anterior thigh） or was closed primarily （3 cases） and had minimal morbidity. Follow-up of 6-12 months showed that the contour of flap was aesthetic and the func- tion of limb was excellent. Conclusion： Our experience indicates that the pedicled latissimus dorsi myocutaneous flap is favorable for recon- struction of large skin and soft tissue defects in the upper extremity

Culture of skin-derived precursors and their differentiation into neurons

Objective:To investigate the culture method of skin-derived precursors (SKPs) and to explore a new cell source for cell transp lantation of central nervous system. Methods:Cells from skins of juvenile and adult mice were iso lated and cultured in serum-free medium. A mechanical method was chosen to pass age these cells and they were identified by the immunocytochemistry assay. Results:SKPs could be isolated from adult and neonatal skins . They could be maintained in vitro for long periods with stable proliferation, and expanded as undifferentiated cells in culture for more than 12 passages. Abo ut 50% of SKPs expressed nestin and majority of these cells expressed fibronecti n when they were plated on polyornithine and laminin coated plates. About 5% cel ls showed neuronal differentiation and expressed neurofilament-M (NF-M) and NS E when SKPs were plated in serum-containing medium, and these cells could also differentiate into adipocytes and fibroblast-like cells. Conclusions:The data support the hypothesis that adult skin contains stem cells capable of differentiating into neurons, adipocytes, and fib roblast-like cells. They may represent an alternative autologous stem cell sour ce for CNS cell transplantation.