RESUMO
PURPOSE: It has been reported widely on various methods of repairing scalp avulsion/defect, including anastomotic vessels for total scalp avulsion and dermal grafts (skin grafting, latissimus dorsi or anterior serratus flap, "visor flap" repair.). The long-term retrospective study, however, with large sample size remains rare; and there is no report on decision-making tree for repairing emergency scalp avulsion/defects under critical conditions. METHODS: The decision-making model is provided for surgeons to design the scalp reconstruction based on the retrospective analysis of 175 cases of scalp avulsion/scalp defect. In this 10-year retrospective study, 175 cases of the repair of scalp avulsion and scalp defects in a single center were analyzed. The clinical decision model was generated based on representative cases. RESULTS: For patients with scalp avulsion/defects, a comprehensive examination and evaluation on systemic injury and complication should be conducted first for saving lives and reducing trauma effects. To make more reasonable clinical decisions, it is also required to determine the location, size, depth of scalp defect the injury area of cranial periosteum, injury of blood vessel or other adjacent organs, and whether the scalp can be reused. Meanwhile, it is necessary to evaluate whether the patient can tolerate long-term anastomotic vascular surgery according to the vital signs and physical status. CONCLUSION: The primary treatment goal is to decrease traumatic effects and save patient's life while repairing and reconstructing scalp avulsions and scalp defects. In addition, it is necessary to comprehensively consider the anatomical, functional and cosmetic characteristics of scalp, surgical equipment, team technical skillsets and patient's own pursuit to optimize a reasonable surgical solution.
Assuntos
Tomada de Decisão Clínica , Avulsões Cutâneas/cirurgia , Serviços Médicos de Emergência/métodos , Modelos Teóricos , Procedimentos de Cirurgia Plástica/métodos , Couro Cabeludo/lesões , Couro Cabeludo/cirurgia , Anastomose Cirúrgica , Feminino , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Masculino , Tratamento de Ferimentos com Pressão Negativa , Estudos Retrospectivos , Transplante de Pele/métodos , Procedimentos Cirúrgicos VascularesAssuntos
Bacteriemia/etiologia , Carbapenêmicos , Pé Diabético/complicações , Pé Diabético/cirurgia , Infecções por Klebsiella/cirurgia , Klebsiella pneumoniae , Perna (Membro)/cirurgia , Pneumonia Bacteriana/etiologia , Pneumonia Bacteriana/microbiologia , Infecções dos Tecidos Moles/etiologia , Infecções dos Tecidos Moles/cirurgia , Idoso , Amputação Cirúrgica , Bacteriemia/microbiologia , Desbridamento , Pé Diabético/microbiologia , Farmacorresistência Bacteriana , Humanos , Infecções por Klebsiella/etiologia , Infecções por Klebsiella/microbiologia , Masculino , Necrose , Tratamento de Ferimentos com Pressão Negativa , Infecções dos Tecidos Moles/microbiologiaRESUMO
OBJECTIVE: To investigate the possibility of differentiation of human mesenchymal stem cells (hMSC) into epidemic cells in vitro. METHODS: hMSCs were segregated from normal adult human bone marrow by Percoll solution (1.073 g/ml) , and were cultured, purified, and amplified to 3th passage in vitro. Then the hMSCs were randomly divided into control group ( with treatment of normal L-DMEM medium) and experimental group (with treatment of L-DMEM medium containing epidermal growth factor,insulin,tretinoin, calcium chloride). After 7 days of culture, the morphologic changes of hMSCs in the 2 groups were observed with inverted phase contrast microscope. The expressions of P63 and PCK of hMSCs were assessed with immunohistochemical methods. RESULTS: The shape of hMSCs in experimental group became irregular or oblong in shape, while that in control group were still in spindle shape. Immunohistochemical results showed that hMSCs were P63 and PCK positive in the experimental group, while those in control group were negative. CONCLUSION: Human mesenchymal stem cells can differentiate into epidemic cell in vitro.
Assuntos
Células da Medula Óssea/citologia , Diferenciação Celular , Células Epiteliais/citologia , Células-Tronco Mesenquimais/citologia , Células da Medula Óssea/metabolismo , Células Cultivadas , Humanos , Queratinas/metabolismo , Proteínas de Membrana/metabolismoRESUMO
OBJECTIVE: To isolate MSCs from adult human bone marrow cells and to induce them into adipocytes. METHODS: MSCs were isolated from adult human bone marrow aspirated by Percoll and expanded in L-DMEM. The surface antigen of MSCs, CD14, CD34, CD45, CD44, VLA-1, HLA-DR and cell cycle were analysed on a FACScan flow cytometer. MSCs were cultured in adipogenisis inducing medium including insulin, 1-methyl-3-isobutylxanthine, indomethine and dexamethasone for 7 days and stained with Oil Red O. RESULTS: MSCs grew as adherent cells and expanded more than 10 passages. They were positive for CD44 and negative for CD14, CD34, CD45, HLA-DR. The expression of VLA-1 was weak. After 7 days of adipocyte inducing, about 85%of the cells displayed accumulation of lipid vacuoles, as detected by Red Oil O. CONCLUSION: MSCs isolated and cultured from adult human bone marrow can be induced to adipogenisis committed differentiation.