A comparative study of surgical outcomes using a Colorado microdissection needle versus standard-size needle electrocautery in one-stage hypospadias repair using a transverse preputial island flap.

BACKGROUND: The purpose of this study was to compare the surgical outcomes of a Colorado microdissection needle (CMN) with that of a standard-size electrocautery needle in one-stage hypospadias repair using a transverse preputial island flap (TPIF). METHODS: The records of patients who received hypospadias repair from September 2012 to October 2013 were retrospectively reviewed. Patients were divided into a group that received repair using a CMN and those in which a standard-size electrocautery needle was used. Data collected and compared included age, types of hypospadias, duration of surgery, intraoperative blood loss, and postoperative edema and complications. RESULTS: There were 51 patients in the CMN group and 44 in the standard needle group, and the groups were similar with respect to age and type of hypospadias. The median surgery time for the CMN group was significantly shorter than that of the standard group (15.7 minutes vs. 20.6 minutes, respectively, P<0.001). At postoperative day 7 and day 30, the CMN group had significantly less patients with edema than the standard needle group (31.4% vs. 65.9%, P<0.01; and 37.3% vs. 79.5%, P<0.001, respectively). The overall complication rate has no significant difference between two groups. CONCLUSIONS: The use of CMN for tissue dissection and separation in hypospadias repair can facilitate foreskin degloving, shape the flap in a more efficient way, and help maintain adequate blood supply for the new urethra and its skin coverage.

A comparison of skin expansion and contraction between one expander and two expanders: a preliminary study.

BACKGROUND: This study aimed to compare the difference between the skin expansion and contraction rates for an expanded flap with one versus two expanders. METHODS: The study cohort comprised 24 cases of two overlapping expanders and 15 cases of a single implanted expander involving 22 patients. The method of "wet-cloth sampling" was applied to measure the expanded flap area and the initial unexpanded area and to calculate the skin expansion rate. Two points 5 cm apart in the center of the expanded flap were selected before the second surgical stage. After removal of the expander, the distance between the two fixed points was measured and recorded. The contraction rate of the expanded flap then was calculated. RESULTS: During the same period of expansion in the two groups (p = 0.06, >0.01), the skin expansion rate was 3.5 ± 0.9 % in the group with two overlapping expanders and 2.6 ± 0.6 % in the control group. The difference between the two groups was statistically significant (p = 0.002, <0.05). The instantly expanded flap contraction rates were 30.3 ± 0.8 and 32.3 ± 0.9 %, respectively for the two groups, and the difference was not statistically significant (p = 0.47, >0.05). We fitted a linear regression model that was Y = 0.533 − 0.003X, where Y was the contraction rate of the expanded flap and X was the period of expansion. The contraction rate of the expanded flap was negatively correlated with the period of expansion. CONCLUSIONS: Compared with the traditional method of implanting a single expander, the new method of overlapping two expanders in a single cavity increased the skin expansion rate. The instantly expanded flap contraction rate did not differ significantly between the two groups, so the amount of expanded skin area absolutely increased. The clinical application of the new method is worth promoting. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

[A comparative study of the skin expansion rate and instantly expanded skin retraction rate between implantation of double overlapping expanders and implantation of one single expander].

OBJECTIVE: To comparatively study the difference of the skin expansion rate and instantly expanded skin retraction rate between implantation of double overlapping expanders and implantation of one single expander. METHODS: From Mar. 2009 to Mar. 2012, 22 cases with 39 sites for skin expansion, received double overlapping expanders in 24 sites, single expander in 15 sites. The area of original skin and expanded skin was measured by "wet-cloth sampling". Then the skin expansion rate was calculated. A distance of 5 cm at the center of expanded skin was re-measured after taking out the expanders. Then the instantly skin retraction rate was calculated. RESULTS: During the same expansion period, the skin expansion rate was (3.5 +/- 0.9)% with the double overlapping expanders and (2.6 +/-0.6)% with one single expander, showing a significant difference between the two groups (P = 0. 002), while the instantly skin retraction rate was not statistically different [(30.3 +/- 0.8)% vs (32.3 +/- 0.9)%; P = 0.47)]. There was a negative relationship between the instantly skin retraction rate and the expansion period (r = -0.768). CONCLUSIONS: The skin expansion rate can be increased with double overlapping expanders, while the instantly skin retraction rate doesn' t decrease. So the skin expansion efficiency is increased to reduce the re-expansion times for the patients with large lesions.

Implant double tissue expanders superposingly in mastoid region for total ear reconstruction without skin grafts.

OBJECTIVE: To present our clinical experience in using two skin soft-tissue expanders implanted superposingly in the mastoid region and Medpor ear framework for congenital microtia reconstruction. METHODS AND MATERIALS: The process of our technique is divided into three stages. In the first surgical stage, a 50 cm(3) and 80 cm(3) kidney-shaped expander is implanted under the fatty layer in mastoid region. Overlay the big expander on the small one. After the first surgery stage they are inflated alternately. In the second surgical stage, we remove two skin soft-tissue expanders and fix the Medpor ear framework to the fascial tissue which is covered by the expanded skin flap wholly without application of fascial flap. In the third stage, we perform the transposition of the auricular lobule to the designated position, construction of the tragus and refinement the new reconstructed ear. From January 2009 to December 2010, 27 patients were treated by this method of total ear reconstruction. RESULTS: 27 patients acquired symmetrical, subtle contour, prominent reconstructed auricles. The new reconstructed ear had a good contour and its skin color and texture were nearly the same as the normal surrounding skin. The postauricular sulcus was stable and satisfactory. The postoperative follow-up time ranged from 1 to 3 years. The expanded skin flap took well without necrosis. Exposure of the skin expander occurred in 2 patients (7.4%). The Medpor ear framework was extrused in one patient (3.7%). In addition, the hematoma was observed in 3 patients (11.1%). No other severe complications happened. CONCLUSION: Overlying implantation of two skin-soft skin expanders solves the problem of insufficient amount of the skin flap, avoids postauricular skin grafting, simplifies the surgical procedure and shortens the operation time significantly.

[Experimental study of tissue-engineered skin loaded with keratinocyte growth factor nanocapsules for skin defect].

OBJECTIVE: To study the effect of tissue-engineered skin loaded with keratinocyte growth factor (KGF) nanocapsules for skin defect on athymic mice. METHODS: The acellular dermal matrix (ADM) loaded with KGF-ADM was constructed by means of phacoemulsification solvent evaporation and low temperature drying. The human epidermal stem cells and fibroblasts were captured and identified, then cultivated on the surface of the KGF-ADM. The cell growth was observed. The tissue-engineered skin without KGF was used as sham group. The autogenous skin graft was used as control group. 2 and 6 weeks after the skin was transplanted to the back of athymic mice, the contraction and histological healing of the transplanted skins were observed respectively. Then the immunofluorescence examination with anti-human K10-FITC and beta1-integrin-Cy3 were applied to detect the origin, growth and differentiation of epidermal and dermal cells in tissue-engineered skin. RESULTS: The epidermal stem cells grew well and attached tightly on KGF-ADM. There were small round stem cells and polygonal terminally-differentiated cells, which appeared a partly cloning growth and a tendency of merging. The tissue-engineered skin with KGF nanocapsules gained better result in repairing the skin defects as compared with the blank group and the control group 2 and 6 weeks after transplantation. The regenerative skin cells could connect and mix closely with the athymic mouse skin cells on the border of skin defect. Meanwhile, the regenerative skin existed some contraction. The histological observation with HE staining showed that the regenerative skin possessed intact epidermis with several cell layers and normal keratose stratum, among which there were still some beta1-integrin (+) cells which represented epidermal stem cells or transient amplifying cells when they were tested by immunofluorescence after 6 weeks of transplantation. CONCLUSIONS: The tissue-engineered skin loaded with KGF nanocapsules had a better result in repairing athymic mice skin defects than common tissue-engineered skin without KGF nanocapsules or skin auto-graft.

A comparative study on two kinds of surgical procedures of penile corpora cavernosa augmentation.

OBJECTIVE: Penile augmentation surgery is still a controversial issue because of the uncertain indication, the possibility of severe complications and a variety of surgical techniques. The purpose of this study is to provide two surgical procedures of penile corpora cavernosa augmentation and to investigate its effect by implanting autogenous saphenous vein grafts or expanded polytetrafluoroethylene (ePTFE) vessel patches. METHODS: Between January 2001 and December 2005, 20 patients underwent surgeries in which bilateral longitudinal incisions were placed on the tunica albuginea and the penile corpora cavernosa were extended by means of implantation of saphenous grafts or PTFE artificial vessel patches. The patients included in this study presented either with congenital idiopathic micropenis or normal penile length and perimeter (dysmorphophobia). Before the operation, the penile length and perimeter in the flaccid and erectile states were as follows: flaccid length 2.5-7.5 cm and flaccid perimeter 3.0-7.5 cm; erectile length 4.9-10.5 cm and erectile perimeter 4.5-10.0 cm. RESULTS: Immediately after surgery, the penile corpus circumferential measurements (on table), showed remarkable increases which were 1.0-2.3 cm and 1.5-3.0 cm in the flaccid and erectile states, respectively; then, at 12 months to 5 years' follow-up, these girth gains had reduced by 0.5-1 cm in some cases. All cases in the two groups obtained satisfactory surgical results with satisfactory erection and no serious complications, such as infection and fistula. In 20 cases, 17 married cases resumed regular and satisfactory sexual activities 1 month after the operation without any functional limitation. CONCLUSION: The two kinds of surgical procedures for augmenting penile corpora cavernosa were proved to be effective and reliable, with few complications. Both saphenous grafts and ePTFE artificial vessel patches are excellent materials for reconstructing the tunica albuginea. These augmenting phalloplasties can not only be used for patients with micropenis, but also applied to satisfy the cosmetic and functional requests of patients with normal penile length and perimeter. However, the long-term outcomes of these surgical procedures need a further, detailed follow-up study.

[Clinical value of serum tissue polypeptide specific antigen detection for primary hepatic cancer].

OBJECTIVE: To evaluate the clinical value of serum tissue polypeptide specific antigen (TPS) for primary hepatic cancer in comparison with alpha-fetoprotein (AFP). METHODS: TPS and AFP were measured by enzyme-linked immunosorbent assay (ELISA) in 85 patients with primary hepatic cancer, 19 with metastatic hepatic cancer, 35 with liver cirrhosis, 22 with chronic hepatitis and 50 healthy control subjects. RESULTS: Serum AFP levels were elevated in patients with hepatocellular carcinoma in comparison with that in cholangiocarcinoma patients (P=0.037), but the difference was not significant (P=0.737). Serum TPS levels were significantly correlated with the tumor size (P=0.001), but not with the number of the tumors, portal invasion, extrahepatic metastasis, clinical stage or histological differentiation (P>0.05). A significant correlation was observed between AFP level and tumor size (P=0.028), portal invasion(P=0.005), and histological differentiation (P=0.000). CONCLUSION: TPS alone offers no more clues than AFP for the diagnosis of primary hepatic cancer, though it can be helpful for the diagnosis of cholangiocarcinoma. It has only limited clinical utility as a marker for primary hepatic cancer.

[Effect of Herceptin combined with Taxol on patients with Her-2/neu overexpressing metastatic breast cancer].

OBJECTIVE: To investigate the efficacy and toxicity of recombinant humanized anti-Her-2/neu antibody (Herceptin) and Taxol for patients with Her-2/neu overexpressing metastatic breast cancer. METHODS: Sixty patients with Her-2/neu overexpressing metastatic breast cancer were investigated. Of the 60 cases, 22 were treated with Herceptin and Taxol and 38 with Taxol and doxorubicin. RESULTS: The total response rate (RR) of Herceptin and Taxol was 68.2%, and that of Taxol and doxorubicin was 44.7%. The RR of patients with Her-2/neu(+++) was 75%, while that of patients with Her-2/neu(++) was 50%. The major adverse effects were gastro-intestinal tract reactions, myopathy, bone marrow suppression and alopecia. CONCLUSION: The treatment with Herceptin and Taxol is effective and safe for patients with Her-2/neu overexpressing metastatic breast cancer. The therapeutic effect is related to the degree of Her-2/neu overexpression.

[Association between the survival time and high-expression of EGFR and HER-2 in breast cancer].

OBJECTIVE: To investigate the relationship between the survival time and the high-expression of epidermal growth factor receptor (EGFR) and human epidermal receptor 2 (HER2) in breast cancer patients, and assess the feasibility of using the two markers either alone or in combination for predicting the prognosis of the patients. METHODS: Breast cancer samples were obtained from 185 patients and measured for the expressions of EGFR and HER-2 by way of immunohistochemistry, and 120 patients (64.9%) were followed up and their survival time recorded. Sixty-five patients (35.1%) failed to be followed for various reasons. RESULTS: Of the 120 patients followed up, death occurred in 28 (15%). Positive HER2 expression was detected in 57.8% and EGFR expression in 40.5% of the all the samples examined. The over-expression of either HER2 or EGFR was in inverse correlation with the survival time (P<0.05 and P<0.01, respectively), and the over-expression of both related to the survival time in similar manner (P<0.05 and P<0.01). CONCLUSION: The high expression of HER2 or/and EGFR suggests a short survival time and an unfavorable prognosis.