Primary repair of broad bilateral complete cleft palate with hard palate rotation flap.

It was hard to achieve primary repair for infants with broad bilateral complete cleft palate, and usually multiple procedures are demanded, resulting in multiple injuries and scar hyperplasia, which could influence infants' long-term phonetic function. In this study, primary repair was carried out on 12 cases of 18- to 30-month-old infants who had complete cleft palate by using rotated hard palate flap with a pedicle on the edge of the fissure modified on the basis of traditional von Langenbeck palatoplasty. Eight infants were subjected to initial phonetic sound evaluation at 1 to 2 years after the operation. All the 12 cases of infant complete cheilopalatognathus had fine healing, and no complications such as dyspnea and fistulous opening in palate were observed. The effects of phonetic sound in 8 infants who had this disease were significantly improved as observed in the long-term follow-up. Thus, we consider it as a reliable and feasible procedure to perform hard palate mucosa rotation flap for the primary repair of broad bilateral complete cleft palate. The procedure is simple, while it produces satisfactory therapeutic effects, by which the patients with complete cleft palate could achieve good recovery in their phonetic functions.

[Immediate reconstruction of tissue defects on eyelid caused by tumor excision].

OBJECTIVE: To introduce the methods for immediate reconstruction of tissue defects on eyelid caused by tumor excision. METHODS: Single or combined local skin flaps were used to repair tissue defects on eyelids after tumor excision. RESULTS: Since 1994, 216 patients (224 sides) were treated. All flaps survived with primary healing. 149 patients were followed up for 3 months to 10 years with satisfactory results. 2 patients with squamous cell carcinoma recurred and reoperated with local skin flap again. CONCLUSIONS: It is a simple, safe, flexible and reliable method to immediately repair the tissue defects with local flaps on eyelid caused by tumor excision.

The island myocutaneous flap reconstruction in electrical burn injuries of severely traumatized cervical region.

Trauma patients with high-energy injuries often present with severe tissue damage that extends beyond the immediate zone of injury and require recruitment of vascularized and massive tissues. The objective of this study was to evaluate the utility of the island myocutaneous flap for the reconstruction of the electrical burn injuries on the cervical region. We conducted a retrospective chart review on all trauma patients treated by the Department of Plastic Surgery at Changhai Hospital, Second Military Medical University who required a large amount of vascularized tissue for the reconstruction of the electrical burn injuries on the cervical region from July 1994 to June 2006. Of them, 23 patients underwent reconstruction of severe traumatic deformities and disfunction on the cervical region with 23 island myocutaneous flaps from adjacent regions. Of the 23 patients, 17 were male and 6 were female, with an average age of 38 years. Conservative surgery method for debriding necrotic tissues and three different types of island myocutaneous flaps, including pectoralis major island myocutaneous flap, latissimus dorsi island myocutaneous flap and trapezius island myocutaneous flap were used. The defect area ranged from 6 cm x 4 cm to 20 cm x 15 cm. The sizes of the dissected myocutaneous flap ranged from 8 cm x 6 cm to 35 cm x 15 cm. All the 23 cases acquired complete recovery. The secondary defect of donor areas had primary closure after being directly sutured or covered with skin grafts. Island myocutaneous flaps have distinctive advantages in treatment of electrical burn injuries on cervical region and it can obtain satisfactory functional and cosmetic outcomes.

Treatment for long-term poorly closed incisions after hepatobiliary surgery.

BACKGROUND: Effective measures are lacking to treat long-term poorly closed incisions after hepatobiliary surgery, including chronic sinus tract and keloid. This study aimed to introduce the treatment experiences with the abdominal wall and costal margin complications after hepatobiliary surgery, and to investigate the method for prevention of this kind of complication. METHODS: We retrospectively studied 26 patients with complications of abdominal wall and costal margin after hepatobiliary surgery, who had been admitted to our hospital since 1998. The 26 patients were classified according to complications into 3 groups: chronic ulcer with costal chondritis (5 patients), single chronic ulcer (3), and keloid (18). According to the symptoms of patients, treatments given included focal removal regional flap transfer restoration and focal removal dermatoplasty combined with glucocorticoid injection, anti-scar medication, external application of silicone gel film, and pressure therapy after surgery to inhibit recurrence. RESULTS: Satisfactory results were observed in the 26 patients after the treatments. Focal and regional ache and itching disappeared, and 2-3-year follow-up revealed no recurrence. CONCLUSIONS: Attention should be paid to patients with complications of abdominal wall and costal margin after hepatobiliary surgery. Combined treatment or mainly operations produce satisfactory result.

[Local flap for reconstruction of nasal tip defect: functional and aesthetic evaluations].

OBJECTIVE: To introduce the experience of reconstruction of nasal tip defect, which could obtain good functional and aesthetic results. METHODS: Based on the aesthetic subunit principle, according to the size, shape, depth of nasal tip defect, and the conditions of surrounding skin, homologous local flap (include: frontonasal flap, bilobed flap, nasolabial flap, reforming rhomboid flap and forehead flap, etc.) was designed to cover the defect wound. The secondary defect of donor area was directly sutured. RESULTS: A total of 83 patients with nasal tip defect were treated by local flap transfers. The area of the defect ranged between 0.6 x 0.6 cm and 2.5 cm x 2.5 cm. The nasal tip defect was successfully closed in all patients, and all flaps survived well without obvious complications. 76 out of these 83 patients were available for follow-up from 1 to 36 months. The repaired tissue was in good match with surrounding tissue, with nice nasal contour, and cosmetic results were satisfactory. No tumor recurrence occurred. CONCLUSIONS: Based on the nasal aesthetic subunit principle, local flap could be used to reconstruct the nasal tip defect below 2.5 cm x 2.5 cm, and obtain good color, contour and texture in match with the surrounding skin. Cosmetic results were satisfactory.

[Discoidin domain receptors (DDRs) expression in pathological scar fibroblast formation].

OBJECTIVE: To explore the role of discoidin domain receptors (DDRs) in the formation of the keloid. METHODS: The real-time quantitative PCR was used to compare the DDRs expression in the keloids and normal fibroblasts. RESULTS: The level of DDR1 expression was significantly higher in keloid than in normal fibroblast (20.98 vs 4.2, P <0.01; 7.9 vs 4.23, P <0.05). The level of DDR1 expression in keloid was also higher significantly than that in hypertropic scar (20.98 vs 7.9, P < 0.01). However, the level of DDR2 expression was somewhat higher in keloid than in normal fibroblasts, the difference seemed not to be significantly in probability (358, 332 vs 278, P > 0.05). CONCLUSIONS: DDRs may exert effect on keloid cell behaviours.

[The effects of chitosan on different-derived fibroblasts].

OBJECTIVE: To investigate the effects of chitosan on the biological activities of the fibroblasts derived from different tissues. METHODS: The biological activities of the fibroblasts derived from different tissues were evaluated with a MTT method for fibroblast proliferation, photic and electronic microscope for morphologic and subcellular structure, 3H-proline uptake method for collagen secretion and ELISA box for the secretion of TGF-beta 1, FGF-AB, and IL-8. RESULTS: This study showed that the chitosan inhabited the proliferation of the fibroblasts and the secretion of the TGF-beta 1, FGF-AB and collagen of the fibroblasts with a dose-depended manner in the normal skin, hypertrophic scar and keloid groups, but it stimulated the IL-8. However, there were no significant differences among the three groups (P > 0.05). CONCLUSION: The chitosan could inhibit the growth, proliferation, biosynthesis and secretion of the fibroblasts, and it may be used to treat different scars.

[Expression of alpha-melanocyte-stimulating hormone in human split-thickness skin graft].

OBJECTIVE: To investigate the expression of alpha-melanocyte-stimulating hormone (alpha-MSH) in human split-thickness skin autograft and the role of alpha-MSH in hyperpigmented process of the grafted skin. METHODS: Immunohistochemical technique was used to detect the expression and distribution of alpha-MSH in the split-thickness grafted skin and normal skin separately. RESULTS: The expression of alpha-MSH in most of the split-thickness grafted skin was much stronger than the control skin. The positive ratio of alpha-MSH expression was 61.1% in the split-thickness grafted skin, 11.1% in the normal skin of the donor area and 16.7% in the normal skin around the recipient area. The expression of alpha-MSH in the split-thickness grafted skin was significant high, compared with the normal skins (P < 0.01). The expression of alpha-MSH in the normal skin of the donor area was no statistic remarkably differences compared to the normal skin around the recipient area. CONCLUSION: The results indicate that the expression of alpha-MSH may markedly increase in the split-thickness grafted skin and correlate with its pigmentation after the skin graft. Overexpression of alpha-MSH may play an important role in hyperpigmented process of the skin graft.