Background Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging.Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies,makin...Background Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging.Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies,making tissue bridging challenging.Methods This study proposes a tissue adhesive in the form of adhesive cryogel particles(ACPs) made from chitosan,acrylic acid,1-ethyl-3-(3-dimethylaminopropyl) carbodiimide(EDC) and N-hydroxysuccinimide(NHS).The adhesion performance was examined by the 180-degree peel test to a collection of tissues including porcine heart,intestine,liver,muscle,and stomach.Cytotoxicity of ACPs was evaluated by cell proliferation of human normal liver cells(LO2)and human intestinal epithelial cells(Caco-2).The degree of inflammation and biodegradability were examined in dorsal subcutaneous rat models.The ability of ACPs to bridge irregular tissue defects was assessed using porcine heart,liver,and kidney as the ex vivo models.Furthermore,a model of repairing liver rupture in rats and an intestinal anastomosis in rabbits were established to verify the effectiveness,biocompatibility,and applicability in clinical surgery.Results ACPs are applicable to confined and irregular tissue defects,such as deep herringbone grooves in the parenchyma organs and annular sections in the cavernous organs.ACPs formed tough adhesion between tissues[(670.9±50.1) J/m^(2) for the heart,(607.6±30.0) J/m^(2) for the intestine,(473.7±37.0) J/m^(2) for the liver,(186.1±13.3) J/m^(2) for the muscle,and(579.3±32.3) J/m^(2) for the stomach].ACPs showed considerable cytocompatibility in vitro study,with a high level of cell viability for 3 d[(98.8±1.2)%for LO2 and(98.3±1.6)%for Caco-2].It has comparable inflammation repair in a ruptured rat liver(P=0.58 compared with suture closure),the same with intestinal anastomosis in rabbits(P=0.40 compared with suture anastomosis).Additionally,ACP-based intestinal anastomosis(less than 30 s) was remarkably faster than the conventional suturing process(more than 10 min).When ACPs degrade after surgery,the tissues heal across the adhesion interface.Conclusions ACPs are promising as the adhesive for clinical operations and battlefield rescue,with the capability to bridge irregular tissue defects rapidly.展开更多
Summary: Poland syndrome is a rare congenital anomaly characterized by the partial or complete absence of the pectoralis major muscle and a wide spectrum of thoracic anomalies, predominantly on the ipsilateral side. T...Summary: Poland syndrome is a rare congenital anomaly characterized by the partial or complete absence of the pectoralis major muscle and a wide spectrum of thoracic anomalies, predominantly on the ipsilateral side. These anomalies include hypoplasia or aplasia of the breast and its components, hypotrophy of subcutaneous fat, and absence of axillary hair, as well as hand deformities that can range from syndactyly to ectrodactyly. The aim of this study was to gather information about patients diagnosed with Poland syndrome at the Central South High Specialty Hospital of Petróleos Mexicanos over a period of 10 years and to identify their reconstructive algorithm. Materials and Methods: A retrospective, observational, and descriptive study was conducted to identify the population diagnosed with Poland syndrome at the “Central South High Specialty Hospital of Petróleos Mexicanos” during the period from 2013 to 2023. Results: The database of patients with Poland syndrome from 2013 to 2023 was analyzed, identifying a total of 8 patients with this diagnosis. Of these, 7 were women (90%) and 1 was a man (10%). The left side was more frequently affected (80%) compared to the right side (20%). The average reconstructive process required two surgical stages, mainly consisting of breast expander reconstruction (first stage) and replacement of the expander with an implant (second stage). Conclusions: Despite being a rare congenital condition, the volume of patients treated at the Central South High Specialty Hospital allows for improved diagnosis and contributes to their reconstructive process. The lack of diagnosis in the male population is notable, likely due to the absence of adequate screening.展开更多
Communication and coordination between orthopedic and plastic surgeons improve outcomes in severe extremity trauma.The“orthoplastics”approach to limb salvage incorporates priorities and skillsets from both fields.Pr...Communication and coordination between orthopedic and plastic surgeons improve outcomes in severe extremity trauma.The“orthoplastics”approach to limb salvage incorporates priorities and skillsets from both fields.Prevention of infection,coordinated skeletal and soft tissue reconstruction,and communication during recovery and rehabilitation are key priorities.The purpose of this review is to describe the orthopedic trauma surgeon’s perspectives on lower extremity reconstruction,including initial management,techniques and timing for provisional and definitive skeletal reconstruction,and considerations for rehabilitation and orthotic use to optimize functional outcomes.展开更多
Shape memory hydrogels(SMHs)have emerged as transformative materials in tissue engineering,owing to their unique ability to recover their original shape after deformation.These hydrogels combine hydrophilicity and ela...Shape memory hydrogels(SMHs)have emerged as transformative materials in tissue engineering,owing to their unique ability to recover their original shape after deformation.These hydrogels combine hydrophilicity and elasticity with shape memory capabilities,making them ideal candidates for various biomedical applications.This review examines their innovative design and synthesis,highlighting the physical and biological charac-teristics that make them well-suited for tissue engineering,such as mechanical properties,biocompatibility,and biodegradability.SMHs have diverse applications in tissue engineering,including bone regeneration,soft tissue reconstruction,and the engineering of vascular and neural tissues.Additionally,they are utilized in smart drug delivery systems and the fabrication of 3D-printed customized implants.Despite these advancements,challenges such as production scalability,optimization of mechanical properties,shape recovery and fixation,controlled degradation,and long-term stability persist.Interdisciplinary approaches are crucial for overcoming these challenges and enhancing their clinical potential.In conclusion,SMHs offer innovative solutions to complex biomedical problems,making them valuable tools for advancing regenerative medicine and improving patient outcomes.展开更多
Obesity is a complex and incompletely understood disease,but current drug screening strategies mostly rely on immature in vitro adipose models which cannot recapitulate it properly.To address this issue,we developed a...Obesity is a complex and incompletely understood disease,but current drug screening strategies mostly rely on immature in vitro adipose models which cannot recapitulate it properly.To address this issue,we developed a statistically validated high-throughput screening model by seeding human mature adipocytes from patients,encapsulated in physiological collagen microfibers.These drop tissues ensured the maintenance of adipocyte viability and functionality for controlling glucose and fatty acids uptake,as well as glycerol release.As such,patients’BMI and insulin sensitivity displayed a strong inverse correlation:the healthy adipocytes were associated with the highest insulin-induced glucose uptake,while insulin resistance was confirmed in the underweight and severely obese adipocytes.Insulin sensitivity recovery was possible with two type 2 diabetes treatments,rosiglitazone and melatonin.Finally,the addition of blood vasculature to the model seemed to more accurately recapitulate the in vivo physiology,with particular respect to leptin secretion metabolism.展开更多
Aim:The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps,by including hyperbaric oxygen(HBO)therap...Aim:The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps,by including hyperbaric oxygen(HBO)therapy in the treatment regimen with flap delay.Methods:We present a prospective study of 23 patients with various types of soft tissue defects of the foot,and lower third of leg managed in our institution from December 2012 to December 2013.All soft tissue defects were treated by a reverse pedicle flap.Twelve patients were managed with flap delay with HBO therapy and 11 patients with immediate flaps without HBO therapy.The postoperative period,hospital course,and follow-up were documented.Results:Of 12 patients with flap delay and HBO,10 patients did not suffer any complications secondary to flap transfer.One patient had discoloration of the tip of the flap,which settled without the intervention,and 1 patient had recurrent abscess formation,which required debridement and closure.Of 11 patients with direct transfer,6 patients presented with complications including flap congestion,partial flap loss,and tip necrosis,which required secondary intervention.Conclusion:HBO therapy is a useful adjunct in flap delay of the reverse pedicle flap for soft tissue reconstruction of the lower third of the leg and foot regions.展开更多
Posttraumatic thumb defects result in significant functional impairment.Multiple reconstructive procedures have been described for the management and improvement of function.Compared with no treatment,all reconstructi...Posttraumatic thumb defects result in significant functional impairment.Multiple reconstructive procedures have been described for the management and improvement of function.Compared with no treatment,all reconstructive methods are beneficial.Each of the available procedures may be more applicable under certain conditions,can offer great benefits,and have its own downsides as well.With a thorough assessment and meticulous technique,the results of thumb reconstruction can be excellent.We present a review of the current reconstructive procedures for traumatic thumb amputation.展开更多
Aim:Scrotal soft tissue loss is a part of the challenging conditions for plastic surgeon.The non-availability of adequate nearby healthy soft tissue and its probability of frequent contamination by excretory substance...Aim:Scrotal soft tissue loss is a part of the challenging conditions for plastic surgeon.The non-availability of adequate nearby healthy soft tissue and its probability of frequent contamination by excretory substances make the issue of reconstruction complicated.The authors present their experience with penoscrotal soft tissue loss with hyperbaric oxygen therapy as an adjunct.Methods:This retrospective study was undertaken in the department of plastic surgery,over a period of 2 years.Nine patients with scrotal or penile injury and infection were enrolled in the study.Age of the patients ranged 20-60 years.Five patients had traumatic loss of scrotal skin and 4 resulted following necrotizing soft tissue infection.All patients underwent hyperbaric oxygen therapy before and following surgery.Results:Healing was complete in all patients with minor complications as partial skin graft loss in 2 patients.Five patients(55.5%)had sustained the soft tissue loss due to trauma.The cause of necrotizing fasciitis was found in 4 patients(44.4%).The mean length of hospital stay was 42.5 days.Conclusion:Management of soft tissue loss of penoscrotal region requires an organized approach and the utilization of newer modalities for early recovery of these injuries is of primary need.Operating surgeons should know the various reconstructive pathways and use of adjunct measures like hyperbaric therapy for early recovery.展开更多
Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons. Here, we present a case of hand reconstruction with a totally laparoscopic peritoneal flap. The anterior ...Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons. Here, we present a case of hand reconstruction with a totally laparoscopic peritoneal flap. The anterior rectus sheath was preserved in situ. The peritoneal free flap supplied by peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover the soft tissue defect of the hand. The defect of the dorsal hand was 17 cm × 12 cm. The peritoneal flap measuring 22 cm × 15 cm survived completely without any complications. A following split-thickness skin graft offered the suc- cessful wound closure. Motor and sensory function improved gradually within the first year follow-up. The totally laparoscopic peritoneal free flap is a good choice for reconstruction of the soft tissue de- fects accompanied by exposed tendons on the hand and foot.展开更多
This paper describes a new technique in the repair of the hand defect with digital extensor tendon injury. The anterolateral thigh flap with the thick femoral fascia has been used in the reconstruction of the composit...This paper describes a new technique in the repair of the hand defect with digital extensor tendon injury. The anterolateral thigh flap with the thick femoral fascia has been used in the reconstruction of the composite defect of the dorsal hand, especially the defect of tendon. This technique requires short period of treatment and hence causes less damage to the donor site but shows a better recovery of the hand function. A favorable curative effect has been obtained in this patient.展开更多
To the Editor Tissue expanders have been widely used in plastic and reconstructive surgery.They induce skin regeneration through mechanical tension and generate new tissue to repair and reconstruct soft tissue defects...To the Editor Tissue expanders have been widely used in plastic and reconstructive surgery.They induce skin regeneration through mechanical tension and generate new tissue to repair and reconstruct soft tissue defects throughout the body[1].The scalp,with its rich blood supply,vigorous cell proliferation and abundant hair follicle stem cells,can yield a significant amount of hair-bearing skin after expansion[2].展开更多
Aim:Crush injuries of the foot are often associated with partial or complete degloving of the heel pad.The purpose of this study is to present an algorithm for the management of various types of heel pad avulsion inju...Aim:Crush injuries of the foot are often associated with partial or complete degloving of the heel pad.The purpose of this study is to present an algorithm for the management of various types of heel pad avulsion injuries,including hyperbaric oxygen(HBO)therapy in the treatment regimen.Methods:We present a prospective study of 27 patients with various types of heel pad avulsion managed in our institution from December 2012 to June 2013.Heel pad avulsion injuries were classified according to the angiosomal pattern.Partial or complete avulsions were classified and treated accordingly.HBO therapy was administered postoperatively.The postoperative period,hospital course,and follow-up were documented in patients with heel pad avulsion injuries.Results:Of 27 patients,20 cases presented with partial avulsion and 7 cases were complete avulsion.Of 20 cases of partial avulsion,one of the flaps was anchored with K-wire.Nineteen cases of partial heel pad avulsion were managed by suturing.Eight patients out of 20 required skin grafting as a secondary procedure at a later date.Out of 7 cases of complete avulsion,one was managed by full-thickness skin grafting,one case by reverse sural artery flap coverage,and four cases were managed by free tissue transfer.No flap revisions were required,and no complications were experienced for the transferred flaps.Conclusion:HBO therapy may be a useful adjunct in the treatment of heel pad avulsion injuries.展开更多
Preservation of the skin envelope and the inframammary fold is the main factor in achieving breast symmetry in unilateral reconstruction.Skin sparing mastectomy(SSM)type-IV followed by immediate autologous reconstruct...Preservation of the skin envelope and the inframammary fold is the main factor in achieving breast symmetry in unilateral reconstruction.Skin sparing mastectomy(SSM)type-IV followed by immediate autologous reconstruction and contralateral symmetrization permits realizing this goal in large,ptotic breasted patients,and tumor superficially located in the inferior quadrants.If the tumor is superficially located in the superior or inferior quadrants with a previous lumpectomy or quadrantectomy scar in the superior quadrants,modified radical mastectomy and a staged procedure are recommended to avoid poor cosmetic results.Two patients who underwent immediate autologous reconstruction following SSM type-V with contralateral symmetrization in a one-stage procedure are presented.展开更多
Aim:Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities.These injuries often complicated by cellulitis,gangrene,regional lymphadenopathy,compartmen...Aim:Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities.These injuries often complicated by cellulitis,gangrene,regional lymphadenopathy,compartment syndrome,bleeding abnormalities,septicemia,hypotension,and disseminated intravascular coagulation,resulting in significant morbidity and mortality.The purpose of the study is to share our experience of hyperbaric oxygen(HBO)therapy in the management of snakebite injuries.Methods:All patients who were treated for snakebite injuries in our department between October 2012 and October 2013 were included in the study.Results:Out of a total 395 patients,174 patients treated with anti-snake venom with a mortality of 17 posttreatment.Forty-four out of the 174 patients was in the pediatric age group.Out of the patients referred to our department,23 presented with cellulitis,7 with compartment syndrome and 17 for the management of soft tissue cover over the extremities.Of the 47 patients,30 involved the lower extremity and rest involved the upper extremity.All patients were subjected to HBO therapy as an adjunct.Six patients required flap cover:cross finger flap(n=2),anterolateral thigh free tissue transfer(n=1),lateral supramalleolar flap(n=1),groin flap(n=1),and dorsal metacarpal artery flap(n=1).There was no need for fasciotomy among the patients who suffered impending compartment syndrome.Conclusion:HBO therapy may reduce the incidence of fasciotomy and increase the effectiveness of plastic surgical modalities if administered early and may be used as a useful adjunct in the management of snake envenomation injury.展开更多
A mangled upper extremity often involves injury to soft tissue,bone,nerves,and vessels and presents a unique challenge to hand surgeons.The complexity of such injuries requires a multidisciplinary approach to achieve ...A mangled upper extremity often involves injury to soft tissue,bone,nerves,and vessels and presents a unique challenge to hand surgeons.The complexity of such injuries requires a multidisciplinary approach to achieve an optimal functional outcome.After obtaining a thorough history and performing a secondary survey,initial management is built upon a strong understanding of the likelihood of limb salvage.Initiation of antibiotics upon presentation,timely and thorough surgical debridement,and early revascularization efforts should be pursued.The surgical team should create a long-term plan involving skeletal stabilization and soft tissue reconstruction along with postoperative rehabilitation and social support.This article reviews current concepts of upper extremity limb salvage and recommendations for surgical management of the mangled extremity.展开更多
基金supported by the National Natural Science Foundation of China (12102388, T2125009, 92048302)the National Key Research and Development Program of China 2017 (YFA0701100)the Fundamental Research Funds for the Central Universities (226-2022-00141, 2022QZJH52)。
文摘Background Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging.Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies,making tissue bridging challenging.Methods This study proposes a tissue adhesive in the form of adhesive cryogel particles(ACPs) made from chitosan,acrylic acid,1-ethyl-3-(3-dimethylaminopropyl) carbodiimide(EDC) and N-hydroxysuccinimide(NHS).The adhesion performance was examined by the 180-degree peel test to a collection of tissues including porcine heart,intestine,liver,muscle,and stomach.Cytotoxicity of ACPs was evaluated by cell proliferation of human normal liver cells(LO2)and human intestinal epithelial cells(Caco-2).The degree of inflammation and biodegradability were examined in dorsal subcutaneous rat models.The ability of ACPs to bridge irregular tissue defects was assessed using porcine heart,liver,and kidney as the ex vivo models.Furthermore,a model of repairing liver rupture in rats and an intestinal anastomosis in rabbits were established to verify the effectiveness,biocompatibility,and applicability in clinical surgery.Results ACPs are applicable to confined and irregular tissue defects,such as deep herringbone grooves in the parenchyma organs and annular sections in the cavernous organs.ACPs formed tough adhesion between tissues[(670.9±50.1) J/m^(2) for the heart,(607.6±30.0) J/m^(2) for the intestine,(473.7±37.0) J/m^(2) for the liver,(186.1±13.3) J/m^(2) for the muscle,and(579.3±32.3) J/m^(2) for the stomach].ACPs showed considerable cytocompatibility in vitro study,with a high level of cell viability for 3 d[(98.8±1.2)%for LO2 and(98.3±1.6)%for Caco-2].It has comparable inflammation repair in a ruptured rat liver(P=0.58 compared with suture closure),the same with intestinal anastomosis in rabbits(P=0.40 compared with suture anastomosis).Additionally,ACP-based intestinal anastomosis(less than 30 s) was remarkably faster than the conventional suturing process(more than 10 min).When ACPs degrade after surgery,the tissues heal across the adhesion interface.Conclusions ACPs are promising as the adhesive for clinical operations and battlefield rescue,with the capability to bridge irregular tissue defects rapidly.
文摘Summary: Poland syndrome is a rare congenital anomaly characterized by the partial or complete absence of the pectoralis major muscle and a wide spectrum of thoracic anomalies, predominantly on the ipsilateral side. These anomalies include hypoplasia or aplasia of the breast and its components, hypotrophy of subcutaneous fat, and absence of axillary hair, as well as hand deformities that can range from syndactyly to ectrodactyly. The aim of this study was to gather information about patients diagnosed with Poland syndrome at the Central South High Specialty Hospital of Petróleos Mexicanos over a period of 10 years and to identify their reconstructive algorithm. Materials and Methods: A retrospective, observational, and descriptive study was conducted to identify the population diagnosed with Poland syndrome at the “Central South High Specialty Hospital of Petróleos Mexicanos” during the period from 2013 to 2023. Results: The database of patients with Poland syndrome from 2013 to 2023 was analyzed, identifying a total of 8 patients with this diagnosis. Of these, 7 were women (90%) and 1 was a man (10%). The left side was more frequently affected (80%) compared to the right side (20%). The average reconstructive process required two surgical stages, mainly consisting of breast expander reconstruction (first stage) and replacement of the expander with an implant (second stage). Conclusions: Despite being a rare congenital condition, the volume of patients treated at the Central South High Specialty Hospital allows for improved diagnosis and contributes to their reconstructive process. The lack of diagnosis in the male population is notable, likely due to the absence of adequate screening.
文摘Communication and coordination between orthopedic and plastic surgeons improve outcomes in severe extremity trauma.The“orthoplastics”approach to limb salvage incorporates priorities and skillsets from both fields.Prevention of infection,coordinated skeletal and soft tissue reconstruction,and communication during recovery and rehabilitation are key priorities.The purpose of this review is to describe the orthopedic trauma surgeon’s perspectives on lower extremity reconstruction,including initial management,techniques and timing for provisional and definitive skeletal reconstruction,and considerations for rehabilitation and orthotic use to optimize functional outcomes.
基金supported by the National Natural Science Foundation of China(82272059 to QY,32401187 to MZ,32171394 to YH,32001008 to YW,U23A20489 to YW)the Postdoctoral Science Foun-dation of China(2023M740258 to MZ)+1 种基金the Postdoctoral Fellowship Program of CPSF(GZC20233397 to MZ)the Fundamental Research Funds for the Central Universities(2022CX01013 to YH,China).
文摘Shape memory hydrogels(SMHs)have emerged as transformative materials in tissue engineering,owing to their unique ability to recover their original shape after deformation.These hydrogels combine hydrophilicity and elasticity with shape memory capabilities,making them ideal candidates for various biomedical applications.This review examines their innovative design and synthesis,highlighting the physical and biological charac-teristics that make them well-suited for tissue engineering,such as mechanical properties,biocompatibility,and biodegradability.SMHs have diverse applications in tissue engineering,including bone regeneration,soft tissue reconstruction,and the engineering of vascular and neural tissues.Additionally,they are utilized in smart drug delivery systems and the fabrication of 3D-printed customized implants.Despite these advancements,challenges such as production scalability,optimization of mechanical properties,shape recovery and fixation,controlled degradation,and long-term stability persist.Interdisciplinary approaches are crucial for overcoming these challenges and enhancing their clinical potential.In conclusion,SMHs offer innovative solutions to complex biomedical problems,making them valuable tools for advancing regenerative medicine and improving patient outcomes.
基金The authors thank Nippon Ham Foods Ltd for their kind donation of collagen.This research was supported by a Kakenhi Grant-in-Aid for Early-Career Scientists(70838523)as well as a grant from the Japanese Ministry of Education,Culture,Sports,Science and Technology(18K09488).
文摘Obesity is a complex and incompletely understood disease,but current drug screening strategies mostly rely on immature in vitro adipose models which cannot recapitulate it properly.To address this issue,we developed a statistically validated high-throughput screening model by seeding human mature adipocytes from patients,encapsulated in physiological collagen microfibers.These drop tissues ensured the maintenance of adipocyte viability and functionality for controlling glucose and fatty acids uptake,as well as glycerol release.As such,patients’BMI and insulin sensitivity displayed a strong inverse correlation:the healthy adipocytes were associated with the highest insulin-induced glucose uptake,while insulin resistance was confirmed in the underweight and severely obese adipocytes.Insulin sensitivity recovery was possible with two type 2 diabetes treatments,rosiglitazone and melatonin.Finally,the addition of blood vasculature to the model seemed to more accurately recapitulate the in vivo physiology,with particular respect to leptin secretion metabolism.
文摘Aim:The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps,by including hyperbaric oxygen(HBO)therapy in the treatment regimen with flap delay.Methods:We present a prospective study of 23 patients with various types of soft tissue defects of the foot,and lower third of leg managed in our institution from December 2012 to December 2013.All soft tissue defects were treated by a reverse pedicle flap.Twelve patients were managed with flap delay with HBO therapy and 11 patients with immediate flaps without HBO therapy.The postoperative period,hospital course,and follow-up were documented.Results:Of 12 patients with flap delay and HBO,10 patients did not suffer any complications secondary to flap transfer.One patient had discoloration of the tip of the flap,which settled without the intervention,and 1 patient had recurrent abscess formation,which required debridement and closure.Of 11 patients with direct transfer,6 patients presented with complications including flap congestion,partial flap loss,and tip necrosis,which required secondary intervention.Conclusion:HBO therapy is a useful adjunct in flap delay of the reverse pedicle flap for soft tissue reconstruction of the lower third of the leg and foot regions.
文摘Posttraumatic thumb defects result in significant functional impairment.Multiple reconstructive procedures have been described for the management and improvement of function.Compared with no treatment,all reconstructive methods are beneficial.Each of the available procedures may be more applicable under certain conditions,can offer great benefits,and have its own downsides as well.With a thorough assessment and meticulous technique,the results of thumb reconstruction can be excellent.We present a review of the current reconstructive procedures for traumatic thumb amputation.
文摘Aim:Scrotal soft tissue loss is a part of the challenging conditions for plastic surgeon.The non-availability of adequate nearby healthy soft tissue and its probability of frequent contamination by excretory substances make the issue of reconstruction complicated.The authors present their experience with penoscrotal soft tissue loss with hyperbaric oxygen therapy as an adjunct.Methods:This retrospective study was undertaken in the department of plastic surgery,over a period of 2 years.Nine patients with scrotal or penile injury and infection were enrolled in the study.Age of the patients ranged 20-60 years.Five patients had traumatic loss of scrotal skin and 4 resulted following necrotizing soft tissue infection.All patients underwent hyperbaric oxygen therapy before and following surgery.Results:Healing was complete in all patients with minor complications as partial skin graft loss in 2 patients.Five patients(55.5%)had sustained the soft tissue loss due to trauma.The cause of necrotizing fasciitis was found in 4 patients(44.4%).The mean length of hospital stay was 42.5 days.Conclusion:Management of soft tissue loss of penoscrotal region requires an organized approach and the utilization of newer modalities for early recovery of these injuries is of primary need.Operating surgeons should know the various reconstructive pathways and use of adjunct measures like hyperbaric therapy for early recovery.
文摘Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons. Here, we present a case of hand reconstruction with a totally laparoscopic peritoneal flap. The anterior rectus sheath was preserved in situ. The peritoneal free flap supplied by peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover the soft tissue defect of the hand. The defect of the dorsal hand was 17 cm × 12 cm. The peritoneal flap measuring 22 cm × 15 cm survived completely without any complications. A following split-thickness skin graft offered the suc- cessful wound closure. Motor and sensory function improved gradually within the first year follow-up. The totally laparoscopic peritoneal free flap is a good choice for reconstruction of the soft tissue de- fects accompanied by exposed tendons on the hand and foot.
文摘This paper describes a new technique in the repair of the hand defect with digital extensor tendon injury. The anterolateral thigh flap with the thick femoral fascia has been used in the reconstruction of the composite defect of the dorsal hand, especially the defect of tendon. This technique requires short period of treatment and hence causes less damage to the donor site but shows a better recovery of the hand function. A favorable curative effect has been obtained in this patient.
基金Funding was provided by Clinical Research Program of Ninth People’s Hospital,Shanghai JiaoTong University School of Medicine(JYLJ202103)The Two-hundred Talent(20191916)the Shanghai Clinical Research Center of Plastic and Reconstructive Surgery supported by the Science and Technology Commission of Shanghai Municipality(22MC1940300).
文摘To the Editor Tissue expanders have been widely used in plastic and reconstructive surgery.They induce skin regeneration through mechanical tension and generate new tissue to repair and reconstruct soft tissue defects throughout the body[1].The scalp,with its rich blood supply,vigorous cell proliferation and abundant hair follicle stem cells,can yield a significant amount of hair-bearing skin after expansion[2].
文摘Aim:Crush injuries of the foot are often associated with partial or complete degloving of the heel pad.The purpose of this study is to present an algorithm for the management of various types of heel pad avulsion injuries,including hyperbaric oxygen(HBO)therapy in the treatment regimen.Methods:We present a prospective study of 27 patients with various types of heel pad avulsion managed in our institution from December 2012 to June 2013.Heel pad avulsion injuries were classified according to the angiosomal pattern.Partial or complete avulsions were classified and treated accordingly.HBO therapy was administered postoperatively.The postoperative period,hospital course,and follow-up were documented in patients with heel pad avulsion injuries.Results:Of 27 patients,20 cases presented with partial avulsion and 7 cases were complete avulsion.Of 20 cases of partial avulsion,one of the flaps was anchored with K-wire.Nineteen cases of partial heel pad avulsion were managed by suturing.Eight patients out of 20 required skin grafting as a secondary procedure at a later date.Out of 7 cases of complete avulsion,one was managed by full-thickness skin grafting,one case by reverse sural artery flap coverage,and four cases were managed by free tissue transfer.No flap revisions were required,and no complications were experienced for the transferred flaps.Conclusion:HBO therapy may be a useful adjunct in the treatment of heel pad avulsion injuries.
文摘Preservation of the skin envelope and the inframammary fold is the main factor in achieving breast symmetry in unilateral reconstruction.Skin sparing mastectomy(SSM)type-IV followed by immediate autologous reconstruction and contralateral symmetrization permits realizing this goal in large,ptotic breasted patients,and tumor superficially located in the inferior quadrants.If the tumor is superficially located in the superior or inferior quadrants with a previous lumpectomy or quadrantectomy scar in the superior quadrants,modified radical mastectomy and a staged procedure are recommended to avoid poor cosmetic results.Two patients who underwent immediate autologous reconstruction following SSM type-V with contralateral symmetrization in a one-stage procedure are presented.
文摘Aim:Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities.These injuries often complicated by cellulitis,gangrene,regional lymphadenopathy,compartment syndrome,bleeding abnormalities,septicemia,hypotension,and disseminated intravascular coagulation,resulting in significant morbidity and mortality.The purpose of the study is to share our experience of hyperbaric oxygen(HBO)therapy in the management of snakebite injuries.Methods:All patients who were treated for snakebite injuries in our department between October 2012 and October 2013 were included in the study.Results:Out of a total 395 patients,174 patients treated with anti-snake venom with a mortality of 17 posttreatment.Forty-four out of the 174 patients was in the pediatric age group.Out of the patients referred to our department,23 presented with cellulitis,7 with compartment syndrome and 17 for the management of soft tissue cover over the extremities.Of the 47 patients,30 involved the lower extremity and rest involved the upper extremity.All patients were subjected to HBO therapy as an adjunct.Six patients required flap cover:cross finger flap(n=2),anterolateral thigh free tissue transfer(n=1),lateral supramalleolar flap(n=1),groin flap(n=1),and dorsal metacarpal artery flap(n=1).There was no need for fasciotomy among the patients who suffered impending compartment syndrome.Conclusion:HBO therapy may reduce the incidence of fasciotomy and increase the effectiveness of plastic surgical modalities if administered early and may be used as a useful adjunct in the management of snake envenomation injury.
文摘A mangled upper extremity often involves injury to soft tissue,bone,nerves,and vessels and presents a unique challenge to hand surgeons.The complexity of such injuries requires a multidisciplinary approach to achieve an optimal functional outcome.After obtaining a thorough history and performing a secondary survey,initial management is built upon a strong understanding of the likelihood of limb salvage.Initiation of antibiotics upon presentation,timely and thorough surgical debridement,and early revascularization efforts should be pursued.The surgical team should create a long-term plan involving skeletal stabilization and soft tissue reconstruction along with postoperative rehabilitation and social support.This article reviews current concepts of upper extremity limb salvage and recommendations for surgical management of the mangled extremity.
