Objective To summarize the effect of free skin graft for repairing scrotal avulsion injury, and to investigate the repair impact of the method on spermatogenesis. Methods Between June 2001 and June 2010, 8 cases of complete avulsion injury of the scrotal skin were treated with the free skin graft, aged 22 to 64 years (mean, 29 years). The causes of injury included machine twisting in 4 cases, animal attack in 3 cases, and traffic accident in 1 case. The time between injury and hospital ization was 1-7 hours (mean, 3.5 hours). Five cases compl icated by avulsion of penile skin, 3 by perineal lacerationwith exposure of testes and spermatic cord, and 1 by avulsion of leg skin. Results After 10 days, 80% to 95% grafted skinsurvived. The reconstructed scrotum had shrinks and the wound healed by first intention after dressing change. Eight patients were followed up 12 to 24 months (mean, 16 months). At last follow-up, the patients had relaxed and droop scrotum, and penile erection was normal. Semen qual ity analysis showed: semen volume of 2-6 mL (mean, 4.2 mL); complete l iquefaction with l iquefaction time of 15-30 minutes (mean, 23 minutes); sperm density of (12-27) × 106/mL (mean, 16 × 106/mL); sperm motil ity of 45%-65% (mean, 56%); and sperm motil ity (grade A) of 25%-42% (mean, 32%). Conclusion Complete avulsion of the scrotal skin can be repaired by free skin graft, which has no significant effect on spermatogenesis.
【Abstract】 Objective To explore the effect of early scrotal dermatoplasty on spermatogenic functional rehabilitation of testis in juvenile pigs with third degree burn wound of the scrotum. Methods Thirty healthy male Guizhou miniature pigs (weighing 10-15 kg, 2-month-old) were divided into 3 groups: control group (group A, n=10), natural healing group (group B, n=10), and dermatoplasty group (group C, n=10). In group A, the pig was not given any treatment; after third degree burn model of the scrotum was prepared, wounds were not treated in group B and the burn skin was excised and whole hypogastric pachydermia was used for dermatoplasty in group C. At 3 months and 1 year after model preparation, bilateral testis were collected from 5 pigs, respectively. HE staining was performed to observe the effects of different repair method on the morphology of spermatogenic cells and immunohistochemical staining was used to detect Survivin protein expression. Results All pigs survived to the end of the experiment and the wound healed successfully. Histological observation showed that spermatogenic cells had normal shape at all stages and mature sperms were seen in lumens in group A; the thickness of seminiferous epithelium was thinner, having one layer or two layers of spermatogenic cells in group B; the spermatogenic cells in group C were slightly more than that in group B with some spermatids; and in groups B and C, the spermatogenic cells at 1 year were more than that at 3 months. Immunohistochemistry staining showed that the Survivin protein expression in groups B and C was less than in group A, and group B was less than group C, showing significant differences at 3 months and 1 year (P lt; 0.05), but no significant difference between 3 months and 1 year in the same group (P gt; 0.05). Conclusion Dermatoplasty has inhibitory effect on spermatogenic functional rehabilitation of testis. Dermatoplasty can decrease spermatogenic cells and reduce Survivin protein expression, but some spermatids still survive in seminiferous tubule.
To explore the effect of burying testis in inguinal pocket on spermatogenesis. Methods Sixty New Zealand rabbits of 6-8 months old included 36 males and 24 females, weighing 2.5-2.7 kg. The male rabbits were randomly divided into the experimental group (n=18)and the control group (n=18). The model of repairing skin defect of scrotum were establ ished by burying testes in inguinal region subcutaneously in the experimental group. The rabbits were not treated in the control group. The sperms were collected and the surface temperature of testis was measured in both groups after 8 weeks. Testes biopsies were harvested from 6 rabbits of 2 groups randomly respectively. The apoptosis of spermatogeniccells was detected with TUNEL. The other 12 male rabbits in two groups were fed respectively with female rabbits to observe the fertil ity. Results The semen density and the spermid activity ratio were (237.3 ± 39.7) × 109/L and 76.9% ± 3.8% in the control group, and were (4.7 ± 2.7) × 109/L and 0 in the experimental group respectively; showing statistically significant difference between two groups (P lt; 0.05). The average superficial temperature of testes was (38.02 ± 0.36)℃ in the experimental group and (36.15 ± 0.64) in the control group (P lt; 0.05). TUNEL results showed: The spermatogenic epithel ium became thin and obvious apoptotic spermatogenic cells were found in experimental group; the spermatogenic epithel ium was normal and few apoptotic spermatogenic cells were found in the control group. The apoptotic index (AI) was 89.69% ± 3.76% in the experimental group and 7.73% ± 4.95% in the control group (P lt; 0.05). The Pairing results showed that the female rabbits pairing with male rabbits of the experimental group were all not pregnant, and those of the control group were all pregnant (P lt; 0.05). Conclusion As the same as the scrotum was reconstructed with skin flaps, it will induce the rabbit infertil ity that the testes were buried in inguinal region subcutaneously to repair defect of scrotum skin. The main reason is the excessive apoptosis of spermatogenic cell by the high testes environmental temperature.
Objective To explore the effect of the first dorsal metacarpal artery-based pedicle dictyo-pattern sublobe flaps in repairing irregular wounds on thumbs and index fingers. Methods From December 2006 to March 2009, 15 patients with irregular wounds on thumbs and index fingers were treated, including 11 males and 4 femals, with an average age of 31 years (range, 18-48 years). Of them, 6 cases of hyperplastic scar of postburn had a 2-25 years course of disease (7.5 years onaverage) and 9 cases of machine injury had a 14-30 days course of disease (20 days on average). In 8 thumb wounds on palmaris, there were 3 cases of rhomboid wounds, 1 case of C-shape wound, and 4 cases of irregular wounds; the area of wounds ranged from 4.5 cm × 3.0 cm to 5.5 cm × 4.5 cm and wounds were treated by the first dorsal metacarpal artery-based proximate pedicle dictyo-pattern sublobe flaps (5 cm × 3 cm to 6 cm × 5 cm). In 7 index fingers wounds on dorsi-fingers, there were 3 cases of 2-wounds, 4 cases of irregular wounds; the area of wounds ranged from 1.0 cm × 0.5 cm to 2.2 cm × 2.0 cm and wounds were treated by the first dorsal metacarpal artery-based distal pedicle dictyo-pattern sublobe flaps (1.2 cm × 0.5 cm to 3.0 cm × 2.2 cm). The donor sites were covered with skin grafts or sutured directly. Results All of the flaps survived completely, the wound of recipient site healed at stage I. The free skin graft on donor site survived completely, the wound of donor site healed at stage I. All cases were followed up for 6-12 months (9 months on average). There was good appearance of flaps. The two point discrimination was 5-7 mm for the proximate pedicle flaps and 9-10 mm for the distal pedicle flaps. The thumbs had digital opposition, opposition function, the index fingers had no dysfunction. According to Hand Surgery Association Society of Chinese Medical Association Society standard for the part function evaluation trial-use of upper l imb, the results of the total active movement were excellent in 14 cases, and good in 1 case. The l ine-scar was existed at donor site of the case of direct suture, the function of thumb web had no dysfunction. Conclusion The first dorsal metacarpal artery-based pedicle dictyo-pattern sublobe flaps can repair the irregular wounds on thumbs and index fingers. It has rel iable blood supply and simple operation.
Objective To explore the effectiveness of thin free lateral femoral circumflex artery perforator flaps that dissected under the superficial fascia in repair of scar contracture deformity in hand and foot. Methods Between January 2017 and October 2020, 15 patients with scar contracture deformity in hand or foot were admitted. There were 9 males and 6 females; aged 6-42 years, with a median age of 23 years. Scar contracture lasted from 1 to 21 years, with a median of 13 years. There were 11 cases of scar contracture deformities in the hands and 4 cases in the feet, all of which showed different degrees of hand and foot joint dysfunction. After the scar contracture was released, the size of wounds ranged from 6 cm×4 cm to 9 cm×8 cm, including 12 cases with exposure of blood vessels, nerves, or tendons, and 4 cases with tendon defects. A thin free lateral circumflex femoral artery perforator flap that dissected under the superficial fascia was used to repair the wound. The size of flap ranged from 6.0 cm×5.0 cm to 10.0 cm×8.5 cm. Fascia strips were used to reconstruct tendons and the donor sites were sutured directly. Results The venous vascular crisis occurred in 1 flap, and the flap survived successfully after treatment. The rest flaps survived well, and the wounds healed by first intention. All incisions at donor sites healed by first intention. All patients were followed up 6-12 months after operation, with an average of 9 months. The flaps were in good shape and texture. The functions of the affected hand had been restored to a large extent. According to the upper limb function evaluation standard of the Society of Hand Surgery of the Chinese Medical Association, 7 cases were excellent and 4 cases were good. The deformity of the toe joint of the affected foot significantly improved. No muscular hernia, sensory numbness, or other complications occurred at the donor sites. Conclusion The thin free lateral femoral circumflex artery perforator flap that dissected under the superficial fascia is an effective method to repair scar contracture deformity of hand and foot with well appearance, good function recovery, and less complication of the donor sites.
Objective To investigate the effectiveness of latissimus dorsi Kiss flap for repairing composite tissue defects and functional reconstruction of upper arm. Methods Between March 2010 and November 2016, 12 cases of composite tissue defects of upper arm were repaired by latissimus dorsi Kiss flap with blood vessel and nerve bunch. There were 8 males and 4 females with a median age of 34 years (range, 21-50 years). The reason of injury included plowing mechanical injury in 4 cases, traffic accident injury in 5 cases, electrical injury in 2 cases, and resecting upper arm soft tissue sarcoma in 1 case. There were deltoid defect in 5 cases, triceps brachii and brachialis defect in 4 cases, and deltoid, triceps brachii, and brachialis damaged in varying degrees in 3 cases. The defect area ranged from 13 cm×7 cm to 20 cm×8 cm. Among them, there were 6 cases of fracture combined with partial bone exposure, one of them with bone defect. The disease duration was 3 hours to 6 months. The flap size ranged from 10 cm×6 cm to 15 cm×7 cm, and the donor sites were directly sutured. Results Twelve flaps survived with primary healing of wounds. Ten patients were followed up 6-26 months (mean, 14 months). At last follow-up, the flaps were soft and the skin color was similar to the surrounding skin. No obvious scar was found at donor sites. The abduction range of motion of shoulder was 30-90°. The muscle strength of brachialis were all at grade 4 or above. The superficial sensation and tactile sensation recovered partialy (S1 in 2 cases, S2 in 6 cases, S3 in 2 cases). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the shoulder joint function was excellent in 2 cases, good in 4 cases, and fair in 4 cases. Conclusion The design of the latissimus dorsi Kiss flaps are flexible, and the donor site can be directly sutured, with the nerves of the latissimus dorsi muscle can partialy reconstruct abduction function of upper arm. In general, the Kiss flap repairing upper arm defect can obtain satisfactory effectiveness.