Objective To investigate the effect of homograft of marrow mesenchymal stem cells (MSCs) seeded onto poly-L-lactic acid (PLLA)/gelatin on repair of articular cartilage defects. Methods The MSCs derived from36 Qingzilan rabbits, aging 4 to 6 months and weighed 2.5-3.5 kg were cultured in vitroand seeded onto PLLA/gelatin. The MSCs/ PLLA/gelatin composite was cultured and transplanted into full thickness defects on intercondylar fossa. Thirty-six healthy Qingzilan rabbits were made models of cartilage defects in the intercondylar fossa. These rabbits were divided into 3 groups according to the repair materials with 12 in each group: group A, MSCs and PLLA/gelatin complex(MSCs/ PLLA/gelatin); group B, only PLLA/gelatin; and group C, nothing. At 4,8 and 12 weeks after operation, the gross, histological and immunohistochemical observations were made, and grading scales were evaluated. Results At 12 weeks after transplantation, defect was repaired and the structures of the cartilage surface and normal cartilage was in integrity. The defects in group A were repaired by the hylinelike tissue and defects in groups B and C were repaired by the fibrous tissues. Immunohistochemical staining showed that cells in the zones of repaired tissues were larger in size, arranged columnedly, riched in collagen Ⅱ matrix and integrated satisfactorily with native adjacent cartilages and subchondral bones in group A at 12 weeks postoperatively. In gross score, group A(2.75±0.89) was significantly better than group B (4.88±1.25) and group C (7.38±1.18) 12 weeks afteroperation, showing significant differences (P＜0.05); in histological score, group A (3.88±1.36) was better than group B (8.38±1.06) and group C (13.13±1.96), and group B was better than group C, showing significant differences (P＜0.05). Conclusion Transplantation of mesenchymal stem cells seeded onto PLLA/gelatin is a promising way for the treatment of cartilage defects.
Objective To evaluate the clinical outcome of the buccal fat pad flap in reconstruction of defects of the oral mucosa. Methods From May 1998 to July 2004, 42 patients with oral mucodefects were treated with buccal fat pad flap. Of them, there were 26 males and 16 females, aging 25-76 years. The defect was caused by buccal squamous carcinoma in 7 cases, by buccal leukoplakia in 5 cases, by squamous carcinoma of soft palate in 7 cases, by adenoid cystic carcinoma of palate in 8 cases, by carcinoma of maxillary sinus in 6 cases, by maxillo-alveolar angioma in 5 cases and by keratocyst of maxilla in 4 cases. The locations were buccal mucosa, maxillary sinus and soft palate. The size of defect ranged from 3.0 cm×3.0 cm to 6.5 cm×4.0cm.Results Forty-one cases achieved healing by first intention, except one case because of large defect. Edema faded and epithelization occurred after 4 weeks of operation. Complete epithelization was observed after 6 weeks of operation. Thirty-five cases were followed up 3 months to 5 years. Therewere no obvious differences in layers, color, elasticity, and texture between repaired region and adjacent mucosa. Conclusion The buccal fat pad flap is useful in reconstructing the muco-defects (less than 6.5 cm in diameter) of the posterior maxilla and buccal region without considerable complication. The multiplex blood supply, facility in accessing and minimal donor site morbidity make it a reliable soft tissue graft. The main shortcoming is its limited size.
Objective To investigate the outcome of repairing hand composite defects using pedicle osteocutaneous groin flap. Methods From February 1998 to May 2004, 33 cases of hand composite defects were repaired with pedicle osteocutaneous groin flap. There were 22 males and 11 females. The age was 19 to 54 years with an average of 243 years. The defect was caused by palmar penetrating injury in 17 cases, by dorsal hand crushing injury in 9 cases and by other injury in 7 cases. Twentythree cases complicated by metacarpal defect, 10 by phalanx defect. Thesize of skin defect was 3.5 cm×2.0 cm to 15.0 cm×10.0 cm, the size of bonedefect was 1.5 to 3.5 cm. After 3 to 7 days of primary debridement, defect was repaired by the pedicle osteocutaneous groin flap based on the superficial circumflex iliac vessels. The flap size was 4.0 cm×2.5 cm to 17.0 cm×11.0 cm. Results All the osteocutaneous flaps survived. During the 4 to 22 months follow-up postoperatively, thetexture, appearance and function of the flap were excellent and bone union was obtained in all cases after 7 to 9 weeks of operation.Conclusion The pedicle osteocutaneous groin flap is an ideal flap to repair the composite defect of the hand, with the benefit of simple procedure and reliable blood supply.
Objective To introduce a method to repair soft tissue defect in different regions and different areas of hand in one procedure. Methods From May 2002 to May 2005, anterolateral femoral flap or lobulated anterolateral femoralflap(forming irregular anterolateral femoral flap) was designed into different shapes to repair multiple soft tissue defect in different regions in hand, whichwas used clinically in 27 cases. Among 27 cases, there were 16 males and 11 females; the locations were left hand in 9 , right hand in 16 and left foot in 2; including 5 penetrating injury, 9 hotpressing injury, 2 soft tissue defection of instep and planta by milled injury, 6 gearing injury and 5 carding machine injury. All the cases complicated by exposure of tendons, bones or joints. Defect was repaired with H-shape flaps in 5 cases of penetrating palm injuries; with Y-shape or K-shape flaps in 11 cases of dorsals or combined with fingers of hand with skin defect; with shape flaps in 3 cases of dorsals combined with sides of palms or the first web of hands with skin defect and in 2 cases of skin defects of dorsals combinedwith palms of feet;with h-shape flaps in 6 cases of skin defects of dorsal or palms combined with disconnected skin defect of fingers. The sizes of main flaps ranged from 6.5 cm×4.8 cm to 17.0 cm×12.0 cm, the sizes of lobulate flaps ranged from 3.5 cm×2.8 cm to 7.5 cm×4.5 cm. Results Allflaps survived without vascular crisis after operation. Except the fascia flapall recipient sites healed by first intention. The follow-up period ranged from 3 months to 1 year, all cases had satisfactory appearance, the texture of flaps was soft. Except 2 cases of penetrating injury, 3 cases of hotpressing injuryand1 case of carding machine injury whose function was not satisfactory, theremaining cases achieved the function of snap and pinch. More than 1 year after operation, the sense of pain and touch recovered. There was no functional impairment at the donor sites although scar hyperplasia was formed in some cases.Conclusion The application of irregular anterolateral femoralflap is an optimal choice for complex skin defect of hand.
Objective To design a combined flap of subscapular axis including vascularized lateral scapular,rib and latissimus dorsi to repair the large defect of tibia. Methods The patient was a 39-year-old man who got a posttraumatic 12 cm defect of tibiaafter primary debridement and external fixation because of open fracture 5 months ago. There was a 12 cm×6 cm scar involved the proximal medial segment of tibia.After resection of scar and fibular tissue over the bone defect floor, alatissimus dorsi myocutaneous flap 14 cm×5 cm pedicled with subscapular artery-thoracodorsal artery,a flap 12.5 cm on the outside of the scapular pedicled with thoracodorsal artery, and 6th rib flap 13 cm by serratus were prepared.The tibialis posterior and saphenous vein were used for astomosis. A proximalanatomic plate was applied to the fixation of tibia. Results Thecompound flap survived the operation. The follow-up period was 2 years. Bone union occurred 6 months after operation. Conclusion This combined flap is successful and can provide alternative to the resolution of large defect of tibia.
Objective To investigate the clinical application and complicationof the lyophilized small-segment allogeneic bone used in repairing bone defectscaused by benign bone tumor and tumor-like lesions after resection and curettage. Methods From December 1999 to December 2005, 230 patients (156 males, 74 females; age, 5-56years, averaged 32.8 years), who had bone defects caused by benign bone tumors and tumor-like lesions after surgical resection and curettage, were treated by the lyophilized small-segment allogeneic bones. The cavities left by the tumor curettage ranged in size from 1.0 cm×0.8 cm to 10.0 cm×2.0 cm, andthe bone defects were about 1.0 to 3.5 cm in diameter after the localized resection of the bones. According to the bone defect degrees, the autogenous nonvascular iliac bone and the bone allograft (0.5-30.0 g) were implanted, followed by the drainage for 2-3 days and the use of antibiotics to prevent infection. The postoperative systemic and local reactions were observed, and the regular X-ray examinations were performed to observe the bone union. ResultsThere was no significant difference in the allergic reactions, such as postoperative temperature, drained amount, and body swelling, between this kind of transplantation and the autogenous bonetransplantation. The wounds in 196 patients were healed by the first intension.The wounds in 34 patients had extravasate. Among them, the wound was healed by changing dressing in 30cases; the wound had delayed healing in 4, including 3 whose wounds were healedby changing dressing for 3-4 weeks,and 1 whose wound was healed by taking out the implants. The follow-up for 6-60 months (average, 38 months) revealed that all the patients had the allograft unions of the bones within 6-18 months after the transplantation, and only 6patients had recurrence of the tumor (3.0%). Evaluated by the Mankin,Komender and WANG Zhiqiang’s standards, 196 (85.22%) patients were satisfied with their outcomes while the other 34 (14.78%) patients were not satisfied. Conclusion The lyophilized small-segment allogeneic bone has a good compatibility and osteogenesis, when it is used in repairing bone defects caused by benign bone tumor and tumor-like lesions after resection and curettage. So, this kind of bone is a good, convenient and safe material for the bone transplantation. The important factors affecting the allograft union are as follows: the mechanical stability in the recipient region, local blood supply, and management of the bone cavity left by resection and curettage of the bone tumor.