RESUMEN
BACKGROUND: Type III circumferential electrical burns of the wrist are one of the most severe electrical injuries, involving rather extensive necrosis, progressive blood circulatory embarrassment and a high amputation rate. This injury poses a challenge for vascular reconstruction and wound coverage. The purpose of this study was to evaluate the effectiveness of the combined rectus abdominis muscle/paraumbilical flap and lower abdominal flap for the treatment of type III circumferential electrical burns of the wrist. METHODS: Six men (age, 19-32 years; average, 21 years) with type III circumferential electrical burns of the wrist were included. After thorough debridement, the volar wound was repaired with a partial rectus abdominis muscle/paraumbilical flap and the dorsal wound was repaired with a lower abdominal flap. RESULTS: Flap survival was complete in all six patients. During a follow-up of 6-12 months, the flaps showed good texture and shape. No abdominal hernia occurred in any patients. The scar on the abdominal wall was acceptable. CONCLUSION: The combined rectus abdominis muscle/paraumbilical flap and lower abdominal flap has large wound coverage potential and offers a new, easy, safe option for the treatment of type III circumferential electrical burns of wrist.
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Pared Abdominal/cirugía , Quemaduras por Electricidad/cirugía , Músculo Esquelético/cirugía , Recto del Abdomen/trasplante , Colgajos Quirúrgicos , Trasplante de Tejidos/métodos , Traumatismos de la Muñeca/cirugía , Adulto , Quemaduras por Electricidad/patología , Supervivencia de Injerto , Humanos , Masculino , Sitio Donante de Trasplante/cirugía , Traumatismos de la Muñeca/patología , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the effect of vascular endothelial growth factor(VEGF) 165 or basic fibroblast growth factor (bFGF), which was slowly-released in fibrin glue patch, on expanded prefabricated flaps in rabbits to facilitate the neoangiogenesis process. METHODS: A total of 53 rabbits were divided randomly into 6 groups. The central auricular vascular bundle of the ear was implanted into the expanded prefabricated flap as the pedicle. Fibrin glue, sandwiched between the expander and the implanted vessels, was adopted for topical delivering and slow-releasing of VEGF(625 ng) or bFGF(2880U). After 14 days, the island flap with the implanted vascular bundles as the pedicle was elevated, sutured back to its original position and then harvested more 3 days later. Neoangiogenesis was measured by digital recording of survival area, laser Doppler flowmetry, PCNA immunohistochemistry, TUNEL, ink and PbO infusions. RESULTS: When compared with the other groups, flap survival improved; neoangiogenesis of flaps increased, together with the blood flow enhanced in the groups applied growth factors. The reduced cellular apoptosis and the increased proliferation were also observed. CONCLUSION: VEGF or bFGF slowly-released by fibrin glue shows the potential to facilitate neoangiogenesis and accelerate maturation of the expanded prefabricated flap.
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Factor 2 de Crecimiento de Fibroblastos/farmacología , Supervivencia de Injerto/efectos de los fármacos , Neovascularización Fisiológica/efectos de los fármacos , Colgajos Quirúrgicos , Factor A de Crecimiento Endotelial Vascular/farmacología , Animales , Apoptosis/efectos de los fármacos , Recuento de Células , División Celular/efectos de los fármacos , Adhesivo de Tejido de Fibrina/farmacología , Supervivencia de Injerto/fisiología , Inmunohistoquímica , Masculino , Conejos , Distribución Aleatoria , Colgajos Quirúrgicos/fisiologíaRESUMEN
OBJECTIVE: To investigate the relationship between Helicobacter pylori (Hp) infection and gastric cancer through the changes of gastric mucosa histopathology within 5 years after Hp eradication in Hp-positive subjects in the high incidence region of gastric cancer. METHODS: One thousand and six adults were selected from general population in Yantai, Shandong Province, the high incidence region of gastric cancer. Gastroscopy and CLO test were performed in all subjects. Biopsy samples from the gastric antrum and body were obtained for histology and assessment of Hp infection. All the Hp-positive subjects were then randomly divided into two groups: treatment group receiving OAC triple therapy and placebo as controls. These subjects were endoscopically followed up in the second and fifth year. In this article, we compared the endoscopic appearance and histology of the biopsy specimens from the same site obtained at the first and final visit. Statistical analysis was done by chi(2) test. RESULTS: All the 552 Hp-positive subjects were randomly divided into treatment group or control group, 276 in each. During the five-year follow-up, the number of patients who continued to be negative or positive for Hp was 161 and 198, respectively. Statistical analysis revealed that: (1) At the initial visit, there were no significant differences in the severity and activity of inflammation between the biopsy specimens from the antrum (P = 0.105) and body (P = 0.084) in both groups. But the proportion of atrophy and intestinal metaplasia in the antrum was much higher than that in the body (P = 0.000). (2) The severity and activity of inflammation in both the antrum and body were markedly reduced after Hp eradication (P = 0.000). (3) Within the five years after Hp eradication, intestinal metaplasia in the antrum regressed or had no progression, while the proportion of intestinal metaplasia in the Hp-positive group increased significantly (P = 0.032). (4) After Hp eradication, the atrophy in both the antrum and body had no significant regression. P value was 0.223 and 0.402, respectively. CONCLUSIONS: Hp eradication results in remarkable reduction in the severity and activity of chronic gastritis, marked resolution of intestinal metaplasia in the antrum. On the other hand, continued Hp infection leads to progressive aggrevation of atrophy and intestinal metaplasia.
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Mucosa Gástrica/patología , Infecciones por Helicobacter/patología , Helicobacter pylori , Adulto , Anciano , Atrofia , Femenino , Estudios de Seguimiento , Mucosa Gástrica/microbiología , Gastritis Atrófica/microbiología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Masculino , Metaplasia , Persona de Mediana Edad , Neoplasias Gástricas/microbiologíaRESUMEN
OBJECTIVE: To evaluate the clinical efficacy of greater omentum in reconstruction of refractory wounds. METHODS: From August 1988 to May 2001, 20 patients with refractory wound underwent pedicle or microvascular free transfer of the greater omentum. Indications of surgery were electrical injury of the wrist and hand in 9 patients, electrical injury of the scalp and cranial bones in 3, avulsion injury of the scalp in 2, radiation-related ulcer of the chest wall in 2, ulcer and osteomyelitis following resection of the sternum sarcoma in 1, electrical injury of the abdomen in 1, bone and soft tissue defects following compound fracture of the leg in 1, and extensive scar and ulcer of the leg and footdrop following trauma in 1. Severe infection and extensive tissue necrosis were present prior to surgical operation in 12 patients. Eleven patients were treated with pedicled omental flaps, and 9 patients with free omental flaps. The size of the omental flaps ranged from 20 cm x 12 cm to 38 cm x 23 cm. RESULTS: All the omental flaps survived. Healing at the first intention of the wounds was achieved in 17 cases. The on-top skin grafts resulted in partial necrosis of lipid liquefaction developed in the omentum and healed with dressing change in 2 cases. A sinus tract of osteomyelitis occurred in one case and healed after delayed excision of the necrosed bone. Follow-up study of all cases from 3 to 24 months showed no recurrent wounds and post-operative abdominal complication. Recovery with acceptable appearance and restoration of function was satisfactory. CONCLUSIONS: Greater omentum provides a well-vascularized tissue with lymphatic ducts for wound coverage. It has strong resistance against infection. It is very malleable and can be molded easily. Therefore it is an ideal tissue in filling cavities and repairing defects, especially in covering large and irregular defects that can not be treated with skin or muscle flaps.
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Epiplón/trasplante , Colgajos Quirúrgicos , Heridas y Lesiones/cirugía , Adolescente , Adulto , Niño , Traumatismos Craneocerebrales/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVE: To review the fundamental research and the experimental study of vascular endothelial growth factor (VEGF). METHODS: The laboratory information and experimental study of VEGF were extensively reviewed. RESULTS: VEGF, as a mitogen specifically for endothelial cells, could strongly stimulate angiogenesis as well as vascular permeability, especially in hypoxia state. Experimentally, survival area and viability of flaps could be increased significantly when exogenous VEGF was applied in the form of protein or cDNA. CONCLUSION: VEGF provides a new way for therapeutic angiogenesis in reparative and reconstructive surgery.