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Reconstruction of post-traumatic upper extremity soft tissue defects with pedicled flaps: An algorithmic approach to clinical decision making

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Chinese Journal of Traumatology 2018年第6期21卷 338-351页

作者： Ravikiran Naalla Shashank Chauhan Aniket Dave Maneesh Singhal department of Plastic reconstructive & Burns Surgery All India Institute of Medical SciencesNew DelhiIndia

Purpose:Pedicled flaps are still the workhorse flaps for reconstruction of upper limb soft tissue defects in many centers across the world. They are lifeboat options for coverage in vessel deplete wounds. In spite of their popularity existing algorithms are limited to a particular region of upper limb;a general algorithm involving entire upper limb which helps in clinical decision making is lacking. We attempt to propose one for the day to day clinical practice.Methods:A retrospective analysis of patients who underwent pedicled flaps for coverage of post-traumatic upper extremity (arm, elbow, forearm, wrist & hand) soft tissue defects within the period of January 2016 to October 2017 was performed. Patients were divided into groups according to the anatomical location of the defects. The flaps performed for different anatomical regions were enlisted. Demographic data and complications were recorded. An algorithm was proposed based on our experience, with a particular emphasis made to approach to clinical decision making.Results:Two hundred and twelve patients were included in the study. Mean age was 27.3 years (range: 1-80 years), 180 were male, and 32 were female. Overall flap success rate was 98%, the following complications were noted marginal flap necrosis requiring no additional procedure other than local wound care in 32 patients (15%), partial flap necrosis requiring flap advancement or extra flap in 15 patients (7%), surgical site infection in 11 patients (5%), flap dehiscence requiring re-suturing in 5 patients (2.4%), total flap necrosis 4 patients (2%).Conclusion:The proposed algorithm allows a reliable and consistent method for addressing diverse soft tissue defects in the upper limb with high success rate.

关键词： Algorithm Upper limb Soft tissue defect Reconstruction Pedicled flaps Decision making

Biobrane^(TM) for burns of the pubic region: minimizing dressing changes

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Military Medical Research 2019年第1期6卷 89-92页

作者： Jia-Jun Feng Jia Le See Abby Choke Adrian Ooi Si Jack Chong department of Plastic Reconstructive and Aesthetic Surgery Singapore General Hospital University of Auckland Faculty of Medical and Health Sciences

Background: The pubic region is often involved in accidental hot water or soup-spill burns. Most of these wounds are superficial partial thickness burns. Due to their proximity to the urinary system, as well as vaginal and anal openings,these burns are easily contaminated. Daily dressings are routinely prescribed as the sole treatment. The cumbersome dressing process is uncomfortable and embarrassing for patients. Biobrane^(TM) is a bilayered biosynthetic dressing. Its coverage of superficial partial thickness burns promotes wound healing and allows one-time application.Case presentations: We report two patients who suffered superficial dermal burns over their pubic region. One patient had 23% total body surface area(TBSA) burns over her lower abdomen, both thighs and pubic region. The second patient had 10% TBSA burns that involved her perineum and the medial sides of both thighs and buttocks.Both were managed with the standard resuscitation protocol in the initial phase. Their burn injuries were managed by shaving, Foley catheterization and Biobrane^(TM) coverage. Their wounds healed uneventfully without complications.Full epithelization was achieved by post-operative day seven. Both patients consented to medical photography and academic publication.Conclusions: Shaving and catheterization improved the hygiene of the burns of the pubic area. The Biobrane^(TM)method circumvents the need of regular dressing changes, eliminating the pain due to dressing changes and preserving patient dignity.

关键词： Pubic Thermal burns Perineum Dressing BiobraneTM

Quinacrine pretreatment reduces microwave-induced neuronal damage by stabilizing the cell membrane

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Neural Regeneration Research 2018年第3期13卷 449-455页

作者： Xue-feng Ding Yan Wu Wen-rui Qu Ming Fan Yong-qi Zhao department of Cognitive sciences Beijing Institute of Basic Medical Sciences Hand & Foot Surgery and Reparative & reconstructive Surgery Center Orthopedic Hospital of the Second Hospital of Jilin University

Quinacrine, widely used to treat parasitic diseases, binds to cell membranes. We previously found that quinacrine pretreatment reduced microwave radiation damage in rat hippocampal neurons, but the molecular mechanism remains poorly understood. Considering the thermal effects of microwave radiation and the protective effects of quinacrine on heat damage in cells, we hypothesized that quinacrine would prevent microwave radiation damage to cells in a mechanism associated with cell membrane stability. To test this, we used retinoic acid to induce PC12 cells to differentiate into neuron-like cells. We then pretreated the neurons with quinacrine （20 and 40 mM） and irradiated them with 50 mW/cm^2 microwaves for 3 or 6 hours. Flow cytometry, atomic force microscopy and western blot assays revealed that irradiated cells pretreated with quinacrine showed markedly less apoptosis, necrosis, and membrane damage, and greater expression of heat shock protein 70, than cells exposed to microwave irradiation alone. These results suggest that quinacrine stabilizes the neuronal membrane structure by upregulating the expression of heat shock protein 70, thus reducing neuronal injury caused by microwave radiation.

关键词： nerve regeneration quinacrine microwave irradiation heat shock cell apoptosis cell necrosis thermal effect cell membrane heat shock protein 70 nerve cells neural regeneration

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

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Chinese Journal of Traumatology 2020年第5期23卷 302-306页

作者： Rana Kapukaya Osman Ciloglu department of Plastic and reconstructive Surgery University of Health SciencesAdana City Research and Training HospitalAdanaTurkey department of Orthopaedic and Traumatology University of Health SciencesAdana City Research and Training HospitalAdanaTurkey

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

关键词： Chronic infected nonunions Two-stage treatment Fibular sliding flap technique

Bone without borders-Monetite-based calcium phosphate guides bone formation beyond the skeletal envelope

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Bioactive Materials 2023年第1期19卷 103-114页

作者： Furqan A.Shah Martina Jolic Chiara Micheletti Omar Omar Birgitta Norlindh Lena Emanuelsson Håkan Engqvist Thomas Engstrand Anders Palmquist Peter Thomsen department of Biomaterials Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden department of Materials Science and Engineering McMaster UniversityHamiltonOntarioCanada department of Engineering sciences Applied Materials Science SectionUppsala UniversityUppsalaSweden department of reconstructive Plastic Surgery Karolinska University HospitalStockholmSweden

Calcium phosphates(CaP)represent an important class of osteoconductive and osteoinductive biomaterials.As proof-of-concept,we show how a multi-component CaP formulation(monetite,beta-tricalcium phosphate,and calcium pyrophosphate)guides osteogenesis beyond the physiological envelope.In a sheep model,hollow dome-shaped constructs were placed directly over the occipital bone.At 12 months,large amounts of bone(~75%)occupy the hollow space with strong evidence of ongoing remodelling.Features of both compact bone(osteonal/osteon-like arrangements)and spongy bone(trabeculae separated by marrow cavities)reveal insights into function/need-driven microstructural adaptation.Pores within the CaP also contain both woven bone and vascularised lamellar bone.Osteoclasts actively contribute to CaP degradation/removal.Of the constituent phases,only calcium pyrophosphate persists within osseous(cutting cones)and non-osseous(macrophages)sites.From a translational perspective,this multi-component CaP opens up exciting new avenues for osteotomy-free and minimally-invasive repair of large bone defects and augmentation of the dental alveolar ridge.

关键词： Bone Calcium phosphate Monetite Calcium pyrophosphate Electron microscopy Raman spectroscopy

Role of adipose tissue grafting and adipose-derived stem cells in peripheral nerve surgery

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Neural Regeneration Research 2022年第10期17卷 2179-2184页

作者： Tiam M.Saffari Sara Saffari Krishna S.Vyas Samir Mardini Alexander Y.Shin department of Orthopedic Surgery Division of Microvascular and Hand SurgeryMayo ClinicRochesterMNUSA Radboud University Medical Center Radboud Institute for Health SciencesDepartment of Plastic SurgeryNijmegenThe Netherlands department of Surgery Division of Plastic and Reconstructive SurgeryMayo ClinicRochesterMNUSA

The application of autologous fat grafting in reconstructive surgery is commonly used to improve functional form.This review aims to provide an overview of the scientific evidence on the biology of adipose tissue,the role of adipose-derived stem cells,and the indications of adipose tissue grafting in peripheral nerve surgery.Adipose tissue is easily accessible through the lower abdomen and inner thighs.Non-vascularized adipose tissue grafting does not support oxidative and ischemic stress,resulting in variable survival of adipocytes within the first 24 hours.Enrichment of adipose tissue with a stromal vascular fraction is purported to increase the number of adipose-derived stem cells and is postulated to augment the long-term stability of adipose tissue grafts.Basic science nerve research suggests an increase in nerve regeneration and nerve revascularization,and a decrease in nerve fibrosis after the addition of adipose-derived stem cells or adipose tissue.In clinical studies,the use of autologous lipofilling is mostly applied to secondary carpal tunnel release revisions with promising results.Since the use of adipose-derived stem cells in peripheral nerve reconstruction is relatively new,more studies are needed to explore safety and long-term effects on peripheral nerve regeneration.The Food and Drug Administration stipulates that adipose-derived stem cell transplantation should be minimally manipulated,enzyme-free,and used in the same surgical procedure,e.***.adipose tissue grafts that contain native adipose-derived stem cells or stromal vascular fraction.Future research may be shifted towards the use of tissue-engineered adipose tissue to create a supportive microenvironment for autologous graft survival.Shelf-ready alternatives could be enhanced with adipose-derived stem cells or growth factors and eliminate the need for adipose tissue harvest.

关键词： adipose tissue adipose-derived stem cells angiogenesis autologous fat grafting nerve injury nerve regeneration paracrine environment peripheral nerve reconstruction stem cell secretome tissue engineering

Human biofield therapy does not affect tumor size but modulates immune responses in a mouse model for breast cancer

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Journal of Integrative Medicine 2016年第5期14卷 389-399页

作者： Gloria Gronowicz Eric R.Secor Jr. John R.Flynn Liisa T.Kuhn department of Surgery University of Connecticut Health Center department of Immunology University of Connecticut Health Center Hartford Healthcare Hartford Hospital Department of Reconstructive Sciences University of Connecticut Health Center

OBJECTIVE： To assess the effect of human biofield therapy, an integrative medicine modality, on the development of tumors and metastasis, and immune function in a mouse breast cancer model. METHODS： Mice were injected with 66cl4 mammary carcinoma cells. In study one, mice received biofield therapy after cell injection. In study two, mice were treated by the biofield practitioner only prior to cell injection. Both studies had two control groups of mock biofield treatments and phosphate- buffered saline injection. Mice were weighed and tumor volume was determined. Blood samples were collected and 32 serum cytokine/chemokine markers were measured. Spleens/popliteal lymph nodes were isolated and dissociated for fluorescent-activated cell sorting （FACS） analysis of immune cells or metastasis assays in cell culture. RESULTS： No signifcant differences were found in weight, tumor size or metastasis. Significant effects were found in the immune responses in study one but no additional effects were found in study two. In study one, human biofield treatment significantly reduced percentage of CD4~CD441oCD25~ and percentage of CD8~ cells, elevated by cancer in the lymph nodes, to control levels determined by FACS analysis. In the spleen, only CD11b~ macrophages were increased with cancer, and human biofield therapy significantly reduced them. Of 11 cytokines elevated by cancer, only interferon-y, interleukin-1, monokine induced by interferon-y, interleukin-2 and macrophage inflammatory protein-2 were significantly reduced to control levels with human biofield therapy. CONCLUSION： Human biofield therapy had no significant effect on tumor size or metastasis but produced significant effects on immune responses apparent in the down-regulation of specific lymphocytes and serum cytokines in a mouse breast cancer model.

关键词： biological therapy breast cancer immune system integrative medicine cytokine energymedicine

A long-term histological research on human frontalis muscle flap specimens from recurrent blepharoptosis patients

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International Journal of Ophthalmology(English edition) 2024年第6期17卷 1161-1163页

作者： Lu Zhou Yu-Cheng Yan Jin-Cai Fan department of Plastic and reconstructive Surgery Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100144China

Dear Editor,We present two patients with recurrent severe blepharoptosis after frontalis muscle(FM)flap suspension.Here we describe long-term histological changes of the FM flaps observed in revision surgeries.FM flap suspension is widely applied in treating severe ptosis with poor levator function(<4 mm),and its effect is relatively stable and lasting[1].FM flap suspension is reliable and recurrent cases are observed only occasionally.Since longterm research about FM flap is rare,we investigated tissue samples of revision surgery flaps which could reflect trends of morphological changes within the functioning FM flaps to some extent.

关键词： patients histological surgery

Stretchable and self-healable hydrogel artificial skin

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National Science Review 2022年第7期9卷 43-55页

作者： Bin Xue Hui Sheng Yongqiang Li Lan Li Weishuai Di Zhengyu Xu Linjie Ma Xin Wang Haoting Jiang Meng Qin Zhibo Yan Qing Jiang Jun-Ming Liu Wei Wang Yi Cao National Laboratory of Solid State Microstructures Department of Physics Nanjing University State Key Laboratory of Pharmaceutical Biotechnology Department of Sports Medicine and Adult Reconstructive Surgery Drum Tower Hospital Affiliated to Medical School of Nanjing University Institute for Brain sciences Nanjing University Chemistry and Biomedicine Innovation Center Nanjing University

Hydrogels have emerged as promising materials for the construction of skin-like mechanical sensors.The common design of hydrogel-based artificial skin requires a dielectric sandwiched between two hydrogel layers for capacitive sensing.However,such a planar configuration limits the sensitivity,stretchability and self-healing properties.Here,we report the design of single-layer composite hydrogels with bulk capacitive junctions as mechanical sensors.We engineer dielectric peptide-coated graphene(PCG) to serve as homogenously dispersed electric double layers in hydrogels.Any mechanical motions that alter the microscopic distributions of PCG in the hydrogels can significantly change the overall capacitance.We use peptide self-assembly to render strong yet dynamic interfacial interactions between the hydrogel network and graphene.The resulting hydrogels can be stretched up to 77 times their original length and self-heal in a few minutes.The devices can effectively sense strain and pressure in both air and aqueous environments,providing tremendous opportunities for next-generation iontronics.

关键词： hydrogel capacitive sensor stretchability self-healing self-assembly