Zhonghua zheng xing shao shang wai ke za zhi = Zhonghua zheng xing shao shang waikf [i.e. waike] zazhi = Chinese journal of plastic surgery and burns最新文献

Objective: This study was aimed at determining the physical and biological properties of fibroin membrane and evaluating its clinical effects.

Methods: 1. The physical and biological properties of fibroin membrane and partial thickness porcine skin were determined with various instruments. The determinations included water ratio, tensile strength, flexibility, water permeability, adhesive force and so on. 2.

Clinical observation: Two wounds with same depth in the same patient were selected. One was covered by fibroin membrane. The other one was treated with 1% SD-Ag cream. The changes in these wounds were observed and compared.

Results: This membrane had nearly same physical and biological properties compared with partial thickness porcine skin. It had no toxicity, irritation, and antigenicity. It possessed certain amount of water permeability and could adhere to the wound. Because of its good transparency, any change in underlying wound could be directly observed. It was helpful not only in local therapy but also in study of wound healing. CLINICAL OBSERVATIONs showed that this membrane had good protecting effect to wound. Its application could obviously relieve pain of wound and the healing time was 3-5 days ahead than that of the control wound.

Conclusion: This membrane was an ideal wound covering and was worth being popularized.

Objective: The aim of this study is to investigate the effect of tangential excision on the local IL-8 release and wound inflammatory response.

Methods: The tissue specimens, which were taken from 7 patients with deep partial thickness burn before and after operation, were both cultured and histopathologically examined. The level of IL-8 in the culture medium was assayed, meanwhile local inflammatory response of tissue samples was evaluated.

Results: The result showed that the level of IL-8 is much lower in the postoperation wounds, while in the non-operation wounds the neutrophil infiltration was marked, with enlargement in necrotic area and disappearance of skin appendages.

Conclusion: The findings suggested that tangential excision could reduce the local production of IL-8 and decrease local inflammatory response, which is helpful to prevent the progressive necrosis of burn wound.

Objective: This paper presents a new method for cleft palate repair.

Method: Six changes have been made to the conventional procedures. After all of these six changes have been carried out on one side of the palate, the operated side becomes completely relaxed. It can be moved both posteriorly and medially to lengthen the side of the palate and to contact with the cleft margin of the non-operated side without tension. Obviously, there is no need to perform the same surgical maneuvers on the other side again. The cleft is then closed by layers.

Result: Totally 151 cases of unilateral and bilateral cleft palate have been repaired with this method. The age of these patients ranged from 4 months to 5 years. Postoperatively, there was neither one death nor one dehiscence. All of the baby patients who received treatment before they began to speak had good quality of speech or near normal speech function.

Conclusion: In the unilateral operation, the surgical trauma, blood loss and time required for the operation are all less than that of conventional procedures which operate on both sides. It is a safer method for early cleft palate repair.

Objective: To determine the kinetics of plasma D(-)-lactate levels in both portal and systemic circulations, and to examine whether elevated plasma D(-)-lactate would correlate to intestinal injury in rats subjected to acute intestinal ischemia-reperfusion.

Methods: Anesthetized rats underwent 75 minutes of superior mesenteric artery occlusion followed by 6 hours of reperfusion. Plasma D(-)-lactate levels were measured by an enzymatic spectrophotometric assay.

Results: It showed that intestinal ischemia for 75 minutes resulted in a significant elevation in D(-)-lactate levels in portal vein blood compared to baseline values (P < 0.05). Plasma D(-)-lactate levels had a tendency to further increase after reperfusion up to 6 hours. Similar alterations in D(-)-lactate were also found in systemic circulation, there were no significant differences between the portal and systemic circulation at any time point. Moreover, the histopathological evaluation scores were significantly correlated to the portal D(-)-lactate levels in animals at various time points (r = 0.415, P < 0.01). In addition, a remarkable rise of endotoxin concentration within portal vein was already found at the end of 75-minute ischemia (P < 0.05), reaching a peak at 2 hours post-reperfusion.

Conclusion: These data suggest that acute intestinal ischemia is associated with failure of mucosal barrier resulting in increased plasma D(-)-lactate levels in both portal and systemic blood. The subsequent reperfusion might cause further increase in D(-)-lactate levels, which correlated to the histopathological alterations. Plasma D(-)-lactate may be a useful marker of intestinal injury following both ischemia and reperfusion insults.

Objective: To elucidate the mechanism of neutrophil aggregation in the liver and the influence of the expression of adhesion molecules after severe burns during early postburn phase, and to explore simultaneously the mechanism of liver damage after severe burns.

Methods: 1. The morphology of the liver and the activation of MPO were observed. 2. The human hepatocytes and hepatic sinusoidal endothelial cells (HSECs) were isolated and cultured, the flow cytometry and micropipette aspiration system were used to observe dynamically the change in intercellular adhesive force between neutrophils and hepatocytes under the influence of burn patient sera. Also the changes in the expression of P-selectin and ICAM-1 on the hepatocytes and HSECs under the influence of burn patient sera were studied.

Results: 1. MPO activation was significantly higher than that in the control group, and reached its peak at 6 hours. Three pieces of liver tissue at 6, 12, 24 hours were examined, and it was found that the Disse's spaces were wide and filled with a great number of PMNs. 2. A constitutive expression of P-selectin and ICAM-1 was found in normal hepatic sinusoidal endothelial cells but not in normal hepatocytes. Under the influence of burn patient sera, the expression of P-selectin increased significantly at 1 hour (P < 0.01) in hepatic sinusoidal endothelial cells but not in hepatocytes, and the expression of ICAM-1 increased significantly at 1 and 2 hour (P < 0.01) in hepatocytes and hepatic sinusoidal endothelial cells. 3. In the presence of burn patient sera, the intercellular adhesive force between neutrophils and hepatocytes reached its peak level at 2 hour after co- cultivation and declined thereafter due to the aggravation of hepatocytic injury. After using ICAM-1 Mab in cultured hepatocytes, the adhesive force reduced significantly.

Conclusion: Neutrophil aggregation in the liver was confirmed after severe burns during early postburn phase. The expression of P-selectin and ICAM-1 on the hepatocytes and HSECs played key roles to neutrophil aggregation in liver after severe burns during early postburn phase, inducing the participation of neutrophils in hepatocyte injury.

Objective: To study the mechanisms of early gastro-intestinal ischemia developed in acute burn period and its relationships with hemodynamic and hemorrheologic changes.

Methods: Twelve pigs were randomly allocated into two groups: group C, a sham group that was subjected to all surgical procedures except burn; group B, 30% TBSA cutaneous thermal injury, and was resuscitated with Parkland formula one hour after burn.

Results: MAP remained stable after burn, but RAP, MPAP, PAWP and CI decreased significantly to the lowest level 4-8 hours after burn, and recovered after resuscitation 24 hours postburn. Intramucosal pH declined immediately (1 hour after burn) and remained abnormal throughout observation period. Portal venous blood flow demonstrated similar changes as pHi, and correlated well with intestinal pHi. Whole blood viscosity and plasma viscosity in portal venous blood elevated obviously after burn.

Conclusions: 1. GI ischemia occurred early and recovered slowly during burn shock phase with conventional resuscitation regime. 2. GI ischemia correlated significantly with portal venous blood flow, but did not with systemic hemodynamic variables. 3. Hemorheologic changes in portal venous blood may exaggerate ischemia injuries.

Objective: This study was to provide a scientific basis for clinical application of denervated muscle transplantation.

Methods: A rhesus monkey was used in this experiment. The denervated extensor digitorum brevis (EDB) and the extensor hallucis brevis (EHB) of the rhesus monkey were autotransplanted in the sacrospinal muscle, and they were biopsied at intervals and stained with HE, Bielshowsky and enzyme. The specimen were examined with light and electro-microscope.

Results: The metabolism of the denervated muscle was lower than the normal. There was muscle regeneration and growing nerve fibers in the graft 12 weeks after transplantation.

Conclusion: Denervated muscle can regenerate in oxygen-deficient environment. If the denervated muscle is in contact with normal muscle, the nerve of the recipient muscle will grow into the graft.

Objective: Septal deformities are very common in patients with unilateral cleft lip nose. The deformities are influential on the morphology of the external nose and respiratory function. The study was conducted to correct the septal deformities.

Method: The operation procedure includes correction and replacement of the deviated septum to the middle position; correction of the displaced alar cartilage with the suspension method and correction of soft tissue deformities of the nose and lip. Twelve patients were treated with this method from 1994 to 1995.

Result: Postoperative follow-up of 3-12 months demonstrated satisfactory results.

Conclusion: Correction of septal deformities plays a very important role in the operation for the unilateral cleft lip nose.

Objective: This study was to determine whether the basic fibroblast growth factor (bFGF) could promote reconstruction of microcirculation in the ischemic portion of a random skin flap.

Methods: Five methods were used in the experiment: measurement of the survival area of the skin flap; light and electron microscopic studies; immunohistochemical observation of the endothelial cell and microvessel image analysis technology (IAT).

Result: The survival area and microvessels in the skin flap were significantly increased in the treated group. The results indicate that bFGF can stimulate the proliferation and differentiation of endothelial cells in vivo and promote the microcirculation of the ischemic flap.

Conclusion: bFGF could promote reconstruction of microcirculation of the ischemic skin flap.