A Modified Suture Technique to Improve Scar Appearance in Wounds Under High Tension.

ABSTRACT: The purpose of this study was to introduce a modified suture technique and to compare its effects on skin scar formation with 2 traditional suture methods: simple interrupted suture (SIS) and vertical mattress suture (VMS). Three groups of healthy adult female Sprague-Dawley rats were selected (6 replicates in each group), and the full-thickness skin of 5 cm × 0.2 cm was cut off on the back of the rats after anesthesia. The wounds were then sutured using 1 of the 3 methods for each group: SIS, VMS, and a newly introduced modified vertical mattress suture (M-VMS) technique with the needle reinsertion at the exit point. A traction device was installed on the back of the rats to achieve high tension wounds. The tensile distance was increased by 1 mm every day for 20 days. After 20 days of healing, the hematoxylin-eosin staining method was used for observation of scar morphology. The collagen production rate was measured by Masson staining, and the type I collagen and type III collagen were detected by the immunofluorescence method. Immunohistochemical staining was used to detect the expression of myofibroblast marker α-smooth muscle actin, and real-time quantitative polymerase chain reaction and Western blot techniques were used to detect the expressions of transforming growth factors TGFß1, TGFß2, and TGFß3 to understand the mechanisms of scar formation. Results showed that the quantity and density of collagen fibers were both lower in the M-VMS group than in the other 2 groups. Immunofluorescence results showed that type I collagen was significantly lower, whereas type III collagen was significantly higher in the M-VMS group than in the other 2 groups. The expressions of α-smooth muscle actin and TGFß1 both were lower in the M-VMS group than in the other 2 groups. The expression of TGFß2 and TGFß3 had no obvious difference among the 3 groups. For wounds under high tension, compared with SIS and VMS methods, the M-VMS technique we proposed can reduce scar formation due to the reduction of collagen formation, myofibroblast expression, and TGFß1 expression.

[An experiment study and clinical observation of the influence of free-skin-grafted scrotal avulsion injuries on spermatogenesis].

OBJECTIVE: To explore the influence of Free-skin-grafted penoscrotal avulsion injuries on spermatogenesis. METHODS: Forty-two male New Zealand albino rabbits during child-bearing period were divided into the experimental group (n = 24) and the control group (n = 18) using random digits table, and 24 female rabbits with reproductive history were used for mating experiment. The experimental group animal's scrotum skin were excised, and the split skin from abdominal region was used to repair the skin defect of scrotum. The control group did not any processing. Six rabbits were randomly chosen respectively in control group and on the 3rd and 8th weekend after the model was successfully established in experimental group. The testicular surface temperature was measured in the eighteen rabbits using the method of burying thermometer, then the testicular biopsy were performed for hematoxylin-eosin (HE) staining. On the 8(th) weekend after the model was successfully established in experimental group, matched-pair feed was performed in the other 12 rabbits respectively in experimental group and in control group. Observation of corresponding mother rabbit fertility. Three patients of penoscrotal avulsion injuries were treated using split skin grafts, and the information of sex life and the quality of sperm were obtained by follow up. RESULTS: The testicular surface temperature was similar on the 3rd and 8th weekend after the model was successfully established in experimental group [(36.15 ± 0.24)°C, (36.77 ± 0.42)°C] with that of the control group. Testis tissue (HE) staining showed the tier of spermatogenic cells was rule arrangement and lot of mature sperms were found in the convoluted seminiferous tubules in control group. The tier of spermatogenic cells was diminished and disposed derangement, the spermatozoa were not seen on the 3(th) weekend of the experiment group. The tier of spermatogenic cells was increased and some spermatozoa were seen on the 8th weekend of the experiment group. Male and female matched-pair feed showed the experimental group conception rate 8/12, and 4.1 ± 3.2 rabbit babies were born averagely, while that of was 12/12 and 6.0 ± 1.3 in control group (P > 0.05). The skin grafts there were some contracture in early stage (1 - 2 months) when the skin grafts applied to repair the avulsing scrotum in three patients. But the skin grafts became loose with downward sagging and there were the good cosmetic result in one year, and without any contracture. The sperm quality was normal after the skin grafts applied to repair the avulsing scrotum in the late stage. CONCLUSIONS: The skin grafting is little arrest the testicle spermatogenesis in the three methods (skin flap reconstruction scrotum, testicle buried, split skin grafting) that have usually been used to repair scrotum skin lose. For a young male, the best treatment for penoscrotal avulsion injuries is free skin grafting, while skin flaps are not recommended for reconstructing the scrotum.

[Clinical efficacy of keloids treated by surgical ablation and immediate postoperative adjuvant radiotherapy].

OBJECTIVE: To evaluate the clinical efficacy of intralesional excision and immediate postoperative adjuvant radiotherapy in the treatment of keloids. METHODS: Eighty-one patients with a combined total of 86 keloids were treated with 6 MeV electron beam radiotherapy after surgical intralesional excision of keloids. All received a total dose of 15 - 20 Gy for 5 consecutive days beginning the day of surgery. The time interval between keloid excision and the delivery of first fraction of radiotherapy was < 6 h. The post-operative follow-up period was 12 - 31 months. RESULTS: Forty-three cases yielded excellent outcomes and there were 18 fair cases. The overall effective rate was 85.9%. There were 10 recurrent cases. Only adverse effects such as delayed wound-healing and telangiectasias (11.3%) were found. Neither severe complications nor secondary malignancies occurred. CONCLUSION: Intralesional excision of keloid and postoperative electron radiotherapy are well-tolerated and efficacious in the prevention of keloid recurrence.

[Anatomical study and clinical applications of the posterior tibial artery intermuscular septum branches island flaps].

OBJECTIVE: To report an anatomical basis for the posterior tibial artery intermuscular septum branches island flaps and its clinical value. METHODS: The origin,course, number, caliber and distribution of the posterior tibial artery intermuscular septum branches were studied in 10 adult cadavers(20 legs). 10 cases of homonymy and opposite side ankle and adjacent soft tissue defects with posterior tibial artery intermuscular septum branches island flaps, aged 20-50 years. Free skin transplantation on the donor sites. RESULTS: The posterior tibial artery gives off 2-7 intermuscular septum branches. Its external diameter was about 0.4-1.8 mm,and the length was about 0.3-4.5 cm. The area of flaps was 7 cm x 6 cm - 20 cm x 8 cm in the group. All the flaps were survived except 1 with partial necrosis in the distant part(3 cm x 1 cm) of the flap. 7 cases were followed up two months to three years. The color, texture and appearance of the flaps were good. CONCLUSIONS: The kind of flap has reliable blood supply, the scope of repairing was wide; avoidance of sacrificing the major artery; the flap was easy to be dissected. It was one of the ideal flaps to repair the ankle and adjacent soft tissue defects.