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The role of vascularization in nerve regeneration of nerve graft

Neural Regeneration Research 2020年第9期15卷 1573-1579页

作者： Tiam M.Saffari Meiwand Bedar Caroline A.Hundepool Allen T.Bishop Alexander Y.Shin department of Orthopedic surgery Mayo ClinicRochesterMNUSA department of Plastic Reconstructive and Hand SurgeryErasmus Medical CenterRotterdamthe Netherlands

Vascularization is an important factor in nerve graft survival and function. The specific molecular regulations and patterns of angiogenesis following peripheral nerve injury are in a broad complex of pathways. This review aims to summarize current knowledge on the role of vascularization in nerve regeneration, including the key regulation molecules, and mechanisms and patterns of revascularization after nerve injury. Angiogenesis, the maturation of pre-existing vessels into new areas, is stimulated through angiogenic factors such as vascular endothelial growth factor and precedes the repair of damaged nerves. Vascular endothelial growth factor administration to nerves has demonstrated to increase revascularization after injury in basic science research. In the clinical setting, vascularized nerve grafts could be used in the reconstruction of large segmental peripheral nerve injuries. Vascularized nerve grafts are postulated to accelerate revascularization and enhance nerve regeneration by providing an optimal nutritional environment, especially in scarred beds, and decrease fibroblast infiltration. This could improve functional recovery after nerve grafting, however, conclusive evidence of the superiority of vascularized nerve grafts is lacking in human studies. A well-designed randomized controlled trial comparing vascularized nerve grafts to non-vascularized nerve grafts involving patients with similar injuries, nerve graft repair and follow-up times is necessary to demonstrate the efficacy of vascularized nerve grafts. Due to technical challenges, composite transfer of a nerve graft along with its adipose tissue has been proposed to provide a healthy tissue bed. Basic science research has shown that a vascularized fascial flap containing adipose tissue and a vascular bundle improves revascularization through excreted angiogenic factors, provided by the stem cells in the adipose tissue as well as by the blood supply and environmental support. While it was previou

关键词： angiogenesis fascial flap nerve graft nerve injury nerve regeneration peripheral nerve vascular endothelial growth factor vascularization vascularized nerve graft

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Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma

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Burns & Trauma 2021年第1期9卷 351-363页

作者： Matthew R.Zeiderman Lee L.Q.Pu Division of Plastic&reconstructive surgery Department of SurgeryUniversity of CaliforniaDavisSacramentoCAUSA

The complex lower extremity wound is frequently encountered by orthopedic and plastic *** in wound care,soft tissue coverage and surgical fixation techniques allow for improved functional outcomes in this patient population with highly morbid *** this review,the principles of reconstruction of complex lower extremity traumatic wounds are *** principles include appropriate initial evaluation of the patient and mangled extremity,as well as appropriate patient selection for limb *** authors emphasize proper planning for reconstruction,timing of reconstruction and the importance of an understanding of the most appropriate reconstructive *** role of different reconstructive and wound care modalities is discussed,notably negative pressure wound therapy and dermal *** role of pedicled flaps and microvascular free-tissue transfer are discussed,as are innovations in understanding of perforator anatomy and perforator flap surgery that have broadened the reconstruction surgeon’s ***,the importance of a multidisciplinary team is highlighted via the principle of the orthoplastic approach to management of complex lower extremity *** completion of this review,the reader should have a thorough understanding of the principles of contemporary lower extremity reconstruction.

关键词： Lower extremity Soft tissue Reconstruction Trauma Surgical approach

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Influence of immobilization and sensory re-education on the sensory recovery after reconstruction of digital nerves with direct suture or muscle-in-vein conduits

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Neural Regeneration Research 2016年第2期11卷 338-344页

作者： Theodora Manoli Jennifer Lynn Schiefer Lukas Schulz Thomas Fuchsberger Hans-Eberhard Schaller department of Hand Plastic and Reconstructive Surgery Burn Unit BG Trauma Center University of Tuebingen

The influence of duration of immobilization and postoperative sensory re-education on the final outcome after reconstruction of digital nerves with direct suture or muscle-in-vein conduits was investigated. The final sensory outcome of 35 patients with 41 digital nerve injuries, who either underwent a direct suture（DS） or a nerve reconstruction with muscle-in-vein conduits（MVC）, was assessed the earliest 12 months postoperatively using static and moving two-point discrimination as well as Semmes-Weinstein monofilaments. There was no significant difference in sensory recovery in cases with an immobilization of 3–7 days versus 10 days in the DS or MVC group. Moreover, no statistically significant difference in sensory recovery was found in cases receiving postoperative sensory re-education versus those not receiving in the DS or MVC group. An early mobilization does not seem to have a negative impact on the final outcome after digital nerve reconstruction. The effect of sensory re-education after digital nerve reconstruction should be reconsidered.

关键词： nerve regeneration peripheral nerve digital nerve sensory re-education immobilization digital direct suture muscle-in-vein conduits

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Progressive disfiguring facial masses with pupillary axis obstruction from Morbihan syndrome:A case report

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World Journal of Clinical Cases 2021年第24期9卷 7163-7168页

作者： Lei Zhang Sheng Yan Lei Pan Su-Fan Wu department of Plastic and reconstructive surgery Plastic and Reconstructive Surgery CenterZhejiang Provincial People’s HospitalAffiliated Hospital of Hangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina department of Plastic and reconstructive surgery Plastic and Reconstructive Surgery CenterZhejiang Provincial People's HospitalPeople's Hospital of Hangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina

BACKGROUND Morbihan syndrome is a rare illness,which presents with recurrent pitting edema on the upper two thirds of the face causing facial contour deformities,and Morbihan syndrome obstructing the pupillary axis with ptosis was seldomly *** SUMMARY A 59-year-old woman presented with a 15-year history of facial swelling that progressively invaded bilaterally from the inner canthus and eyelids *** examination indicated that the bilateral periorbital and the left temporal soft tissues had swelling without cranium *** analysis showed a large amount of lymphocyte infiltration,and immunohistochemistry showed positive expression of CD68 in clear-cut granulomas and D2-40 in the lymphatic ***,the clinical diagnosis of Morbihan syndrome was *** Morbihan syndrome is an infrequent and refractory disease,which is characteristic with recurrent woody facial edema on the upper two thirds of the *** facial edema is persistent and non-pitting,causing facial contour deformities and even vision field *** diagnosis of Morbihan syndrome depends on clinical features,imaging information,and *** is optional to improve the visual field for these patients with severe pupillary axis obstruction.

关键词： Morbihan syndrome Pupillary axis obstruction Ptosis Facial mass Vision impairment Case report

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Gangrenous cholecystitis: A silent but potential fatal disease in patients with diabetic neuropathy. A case report

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World Journal of Clinical Cases 2018年第15期6卷 1007-1011页

作者： Melorin Mehrzad Charles C Jehle Lauren O Roussel Raman Mehrzad department of Plastic and reconstructive surgery Rhode Island Hospital Brown University

Gangrenous cholecystitis(GC) is a severe and potentially deadly complication of acute cholecystitis. We present a 83-year-old gentleman with a past medical history of type 2 diabetes mellitus with significant associated neuropathy, presenting to a community hospital in a major metropolitan area with 10 days nausea and vomiting and a benign abdominal exam. While the patient was admitted for hyperglycemia, he was subsequently found to have severe GC requiring urgent surgical intervention.

关键词： Gangrenous cholecystitis Diabetes mellitus Hyperglycemia Complications Case report

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The interaction of stem cells and vascularity in peripheral nerve regeneration

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Neural Regeneration Research 2021年第8期16卷 1510-1517页

作者： Sara Saffari Tiam M.Saffari Dietmar J.O.Ulrich Steven E.R.Hovius Alexander Y.Shin Division of Hand and Microvascular surgery Department of Orthopedic SurgeryMayo ClinicRochesterMNUSA department of Plastic and reconstructive surgery Radboud University Medical CenterNijmegenthe Netherlands

The degree of nerve regeneration after peripheral nerve injury can be altered by the microenvironment at the site of injury. Stem cells and vascularity are postulated to be a part of a complex pathway that enhances peripheral nerve regeneration;however, their interaction remains unexplored. This review aims to summarize current knowledge on this interaction, including various mechanisms through which trophic factors are promoted by stem cells and angiogenesis. Angiogenesis after nerve injury is stimulated by hypoxia, mediated by vascular endothelial growth factor, resulting in the growth of preexisting vessels into new areas. Modulation of distinct signaling pathways in stem cells can promote angiogenesis by the secretion of various angiogenic factors. Simultaneously, the importance of stem cells in peripheral nerve regeneration relies on their ability to promote myelin formation and their capacity to be influenced by the microenvironment to differentiate into Schwann-like cells. Stem cells can be acquired through various sources that correlate to their differentiation potential, including embryonic stem cells, neural stem cells, and mesenchymal stem cells. Each source of stem cells serves its particular differentiation potential and properties associated with the promotion of revascularization and nerve regeneration. Exosomes are a subtype of extracellular vesicles released from cell types and play an important role in cell-to-cell communication. Exosomes hold promise for future transplantation applications, as these vesicles contain fewer membrane-bound proteins, resulting in lower immunogenicity. This review presents pre-clinical and clinical studies that focus on selecting the ideal type of stem cell and optimizing stem cell delivery methods for potential translation to clinical practice. Future studies integrating stem cell-based therapies with the promotion of angiogenesis may elucidate the synergistic pathways and ultimately enhance nerve regeneration.

关键词： angiogenesis exosomes nerve graft nerve regeneration peripheral nerve injury revascularization Schwann cells stem cells stem cell delivery vascularity

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Sensory reinnervation of free flaps in reconstruction of the breast and the upper and lower extremities

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Neural Regeneration Research 2012年第29期7卷 2279-2285页

作者： Nektarios Sinis Androniki Lamia Helml Gudrun Thomas Schoeller Frank Werdin department of Plastic Hand-and Reconstructive MicrosurgerySt.Marien Krankenhaus BerlinBerlin 12249 Germany department of Handsurgery Microsurgery and Reconstructive Surgery of the Breast Marienhospital StuttgartStuttgart 70199Baden-Württemberg Germany department of Handsurgery Microsurgery and Reconstructive Surgery of the Breast Marienhospital StuttgartStuttgart 70199Baden-Württemberg Germany

There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.

关键词： free tissue flap mammaplasty dermatoplasty free tissue transfer flap free microvascular tissuetransfer breast reconstruction extremity reconstruction sensate flap non-sensate flap

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Clinical value of combining epirubicin with mindfulness intervention in patients with urinary system tumors and depression

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World Journal of Psychiatry 2025年第1期15卷 54-62页

作者： Juan Liu Yan-Ping Guo Yan-Mei Lu Bei-Lin Wang department of Urology surgery Zhumadian Central HospitalZhumadian 463000Henan ProvinceChina department of Psychiatry Zhumadian Mental HospitalZhumadian 463000Henan ProvinceChina

BACKGROUND Urinary system tumors often cause negative psychological symptoms,such as depression and dysphoria which significantly impact immune function and indirectly affect cancer *** epirubicin(EPI)is recommended by the European Association of Urology and can improve prognosis,its long-term use can cause toxic side effects,reduce treatment compliance,and increase psycho-logical ***,an appropriate intervention mode is *** This was a retrospective study including 110 patients with urinary system tumors and depression admitted to Zhumadian Central Hospital between March 2021 and July *** were divided into conventional(n=55)and joint inter-vention(n=55)*** conventional group received mitomycin and routine nursing,while the joint intervention group received EPI and mindfulness *** groups underwent three cycles of *** function(CD4+cells,CD8+cells,CD4+/CD8+ratio),tumor marker levels[urinary bladder cancer antigen(UBC),bladder tumor antigen(BTA)and nuclear matrix protein 22(NMP22)],quality of life questionnaire-core 30(QLQ-C30),17-item Hamilton depression scale(HAMD-17),and cancer-related fatigue[cancer fatigue scale(CFS)]were *** reactions and nursing satisfaction were recorded and *** Post-intervention,CD4+,CD8+,and CD4+/CD8+levels increased in both groups,with the joint intervention group showing more significant improvement(Pjoint intervention group compared to the conventional group(Pjoint intervention group also showed a greater reduction in HAMD-17 scores(9.38±3.12 vs 15.45±4.86,Pjoint intervention group had a lower incidence of adverse reactions and higher nursing satisfaction(P<0.05).CONCLUSION EPI combined with mindfulness intervention significantly improved clinical outcomes in patients with urinar

关键词： Urinary system tumor Bladder cancer Prostate cancer Depression Epirubicin

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Rare case of compartment syndrome provoked by inhalation of polyurethane agent:A case report

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World Journal of Clinical Cases 2022年第22期10卷 8003-8008页

作者： Jun Ho Choi Hyun Myung Oh Jae Ha Hwang Kwang Seog Kim Sam Yong Lee department of Plastic and reconstructive surgery Chonnam National University HospitalGwangju 61469South Korea department of Plastic and reconstructive surgery Chonnam National University Medical SchoolGwangju 61469South Korea

BACKGROUND The most common causes of compartment syndrome in the lower extremities include lower limb fractures,trauma-induced crushing injuries,severe burns,and non-traumatic ***,there have been no reports of compartment syndrome secondary to toxic *** SUMMARY A 59-year-old man,who lost consciousness after applying polyurethane-based paint on a water tank,was brought to the emergency *** initial blood test showed apparent *** day later,pain and swelling in both legs were observed,and the physical examination confirmed the presence of compartment ***-incision fasciotomy was performed on both *** dressings and negative pressure wound treatment were done on both legs,and skin grafting was performed after healthy granulation tissue had been *** other complications were observed after ***,symptoms of peroneal neuropathy,particularly limited ankle dorsiflexion and reduced sensation on the lower extremities,were *** Workers using polyurethane agents should wear gas masks and be evaluated for compartment syndrome and rhabdomyolysis secondary to toxic inhalation.

关键词： Compartment syndrome Polyurethanes Rhabdomyolysis Hypoxia Peroneal neuropathies Case report

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Open wedge re-correction high tibial osteotomy in an elderly patient with a varus angulated non-united dome-shaped high tibial osteotomy

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2013年第11期14卷 1054-1058页

作者： Steffen SCHROTER Lukas KONSTANTINIDIS Tobias M. KRAUS Fabian STUBY Ulrich STOCKLE Thomas FREUDE department of Traumatology and reconstructive surgery BG Trauma Center department of Orthopaedics and Trauma surgery University Medical Centre Freiburg

The high tibial osteotomy(HTO)is a wellestablished and commonly used treatment for younger and active patients with a medial unicompartmental osteoarthritis of the knee and varus *** aim of this technique is to shift the load to a functional lateral compartment in order to delay total knee *** dome-shaped HTO was introduced by Blaimont et al.(1975)and later popularized by Maquet(1980).Out of 118 cases,96 cases of overcorrection,13 cases of undercorrection,and 9 cases

关键词： HTO MPTA high

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