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PubMed2002

[Incidence of congenital defects in selected areas and countries 1998-1998].

OBJECTIVE: Presentation of the incidence of selected types of birth defects in registers of birth defects abroad and in comparison with data from the Czech Republic in 1988-1998. DESIGN: Retrospective epidemiological analysis of the incidence of birth defects. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: Analysis of the incidence of 15 types of selected birth defects in liveborn and stillborn infants in 1988-1998 according to published data and publications of the International Clearing-house for Birth Defects Monitoring Systems (ICBDMS) and European Registration of Congenital Anomalies (EUROCAT). Comparison of the incidence of 15 selected types of congenital defects from 24 registers worldwide incl. the Czech Republic. RESULTS: In the resultant incidences of selected types of congenital defects during the presented period participate geographical and ethnic differences as well as a series of other factors, in particular primary and secondary prevention of birth defects. The influence of other biosocial factors is assumed. CONCLUSION: Long-term well functioning registration of birth defects is an essential prerequisite not only for national analyses but also for possible more detailed collaboration and analyses on an international scale.

Congenital Abnormalities↗
PubMed2003

[Functional implantation reconstruction of acquired jaw defects after tumor resection].

OBJECTIVE: Partial or full defects of jawbone following tumor resection frequently lead to a loss of mastication, an impaired speech function and a severe deformity of appearance. To improve the life quality of such patients, implantation or bone grafting-combined implantation was utilized to functionally reconstruct the jaw defects. METHODS: 1. Fragmental or full mandibular defects were reconstructed by vascularized or non-vascularized bone grafts in combination with immediate or delayed implants. 2. The unilateral maxillary defect with an edentulous counter-side was rehabilitated by a prosthesis secured on implants placed on the healthy side. 3. For bilateral maxillary defect, implants were placed in the zygmatic bone or augmented zygmatic bone to support a prosthesis with magnetic retention. RESULTS: 64 jaw defects (10 in maxilla; 54 in mandible) were reconstructed by three different methods to restore the appearance and functions. The longest follow-up period was 12 years and the shortest 5 year, only 6 implants were lost due to failure of osseointegration. The implant survival rate for the maxillary defects was 97.5%, for the mandibular defects with vascularized bone grafts was 97.1%, and with non-vascularized bone grafts was 97.7%. CONCLUSIONS: Implants-borne prosthesis is an applicable technique in restoration of maxillary defects. In case of insufficient zygomatic thickness, bone augmentation is often needed prior to implantation. As for the mandibular reconstruction, bone grafting in combination with implantation is an ideal method. Compared to non-vascularized bone grafting, the vascularized method is much more suitable for bone grafting beds with poor blood supply. From the practical point of view, non-vascularized bone graft in combination with implantation is more practicable. The reduced off-body time of bone grafts from donor to recipient site keeps most of osteoblasts vital and enables simultaneous implants to achieve osseointegration. This confirms the osteogenesis, osteoconduction and osteoinduction of bone autografts.

Adolescent↗
PubMed2002

Type and extent of enamel defects in juvenile idiopathic arthritis (JIA).

AIM: To establish whether there is an increased prevalence and extent of enamel defects associated with Juvenile Idiopathic Arthritis (JIA) in patients in the North of England. STUDY DESIGN: clinical examination of subjects and age and sex matched controls. METHODS: The labial surfaces of all erupted permanent teeth in subjects, as well as age and sex matched controls, were examined. They were classified for type and extent of defects according to the Modified DDE index. The records of 146 subjects and 142 controls were available for analysis. STATISTICS: defects were expressed as the percentage of subjects or controls with or without any defects or specific types of defect. Fisher's exact test was used to compare the prevalence of disease in the two groups with significance being accepted at the 5% level. In addition, 95% confidence intervals for the relative risk of disease in the two groups were derived. RESULTS: There was no significant difference between subjects and controls for the presence of any type of defect (p=0.48), demarcated opacities (p=0.39), diffuse opacities (p=0.71), or hypoplasias (p=0.19). There was no significant increase in severity of defects in subjects compared with controls. There was also no significant difference when comparing the group diagnosed before the age of 4 (0-3) and the group diagnosed after the age of 4 (>4) years. CONCLUSION: There was no greater overall prevalence of enamel defects or specific type of defects and no greater extent of them in subjects with JIA compared with age and sex matched controls.

Journal Article↗
PubMed2003

[An experimental study of demineralized bone matrix to repair bone defects as a scaffold of tissue engineering].

OBJECTIVE: To evaluate application of the sponge of demineralized bone matrix (SDBM) in tissue engineering of bone. METHODS: SDBM was prepared from long bone of rabbits. Bone marrow cells were flushed from the bone shaft of femurs of a two-month-old New Zealand white rabbit. After the cells were cultured for 9 days, the flasks were added into dexamethasone (10(-8) mol/L), beta-glycerophosphate sodium (10 mmol/L) and L-ascorbic acid (50 micrograms/ml). After 5 weeks, the cultured cells were collected and marked by 5-Bromo-2'-dexyouridine (BrdU). The grand sum of cells seeded on a piece of SDBM was about (4-6) x 10(6). The composites of cells and SDBM (tissue engineered chip, TEC) were implanted into muscles and bone defects of radius in rabbits. A standard procedure was applied to make a 10 mm long defect bilaterally in the radius of nine skeletally mature male New Zealand white rabbits. All of the 18 defects were randomly divided into three groups: group I, six defects were grafted by TEC; group II, six defects were grafted with SDBM alone; group III, six defects were empty. RESULTS: The results of radiographic and histological evaluation showed that all of the defects were repaired in group I and group II at 6 weeks, none of the defects was repaired in group III. The results of BrdU staining showed that the staining was positive in group I, but negative in group II. Biomechanical test showed that the compressive ultimate strength (CUS) of new bone in TEC implanted group was comparable with normal radius (P = 0.623) and in SDBM implanted group was significant lower than normal radius (P = 0.038). CONCLUSIONS: The TEC can form cartilage and bone tissue in muscles and repair segmental bone defects. SDBM is a kind of effective natural scaffold in tissue engineering of bone.

Animals↗
PubMed2003

[Repair of bone defect with compound of coralline hydroxyapatite porous, fibrin sealant and Staphylococcus aureus injection].

OBJECTIVE: To investigate the ability of repairing bone defect with the compound of coralline hydroxyapatite porous (CHAP), fibrin sealant(FS) and staphylococcus aureus injection (SAI), and the feasibility to use the compounds as bone substitute material. METHODS: The animal model of bone defect was made on the bilateral radius of 54 New Zealand white rabbits, which were randomly divided into the experimental group(the defect was repaired with CHAP-FS-SAI), control group(with autograft) and blank control group(the defect was left unrepaired) with 18 rabbits in each group. The ability of bone defect repair was evaluated by gross observation, histopathological study, X-ray and biomechanical analysis 2, 4, 8 and 12 weeks after repair. RESULTS: (1) In the 2nd week, tight fibro-connection could be found between the implant and fracture site and there were many fibroblasts and capillary proliferation with many chondrocytes around CHAP in the experimental group, while only a few callus formed, and chondrocytes, osteoblast and osteoclast existed in the control group. (2) In experimental group and control group, a large quantity of callus was found 4 and 8 weeks; ossification of chondrocytes with weave bone formation were found 4 weeks and many osteocytes and weave bones and laminar bones were found 8 weeks. (3) In the 12th week, the complete ossification of implant with well bone remodeling, a large number of mature osteocytes and laminar were found in experimental group and control group, and CHAP still existed in the experimental group; the defect area filled with fibro-scar tissue and only many fibroblasts could be seen in blank control group. (4) X-ray findings were the following: In experimental and control groups, callus formation could be seen 2 weeks postoperatively, more callus formed 4 weeks, the bone defect area disappeared and CHAP scattered in the callus 8 weeks; the fracture line disappeared and medullary cavity became united (in control group); and in the 12th week, the cortex became continuous, the medullary cavity became united, and remodeling completed, while bone defect was not still united in blank control group. The maximal torque and torsional stiffness in the experimental group is higher than those in the control group 2 weeks (P < 0.05), but there was no significant difference (P > 0.05) between the two groups 4, 8, 12 weeks after repair. CONCLUSION: The compound of CHAP-FS-SAI has good biological compatibility, and it can be used for one kind of bone substitute material to repair the bone defect.

Animals↗
PubMed1992

The effect of a composite of polyorthoester and demineralized bone on the healing of large segmental defects of the radius in rats.

The effect of a composite of demineralized bone mixed with polyorthoester on the healing of large segmental defects in the rat radius was studied. Sixty male Wistar rats were divided into four groups, A through D, and an osteoperiosteal diaphyseal defect of 50 per cent of the length of the bone was made in the right radius of each rat. In Group A, the defect was filled with polyorthoester and demineralized bone; in Group B, demineralized bone; and in Group C, polyorthoester. No material was implanted in the defects in the Group-D rats. The rats were killed fifty days postoperatively. The formation of bone in the defects was quantified with computer-assisted measurements of the area on radiographs. The host-tissue response was evaluated with light microscopy. Defects that had been filled with the composite of polyorthoester and demineralized bone or with demineralized bone alone showed regeneration of bone corresponding to 93.6 and 77.6 per cent of the area of the defect, respectively. Defects that had no implant or that had been filled with polyorthoester alone showed significantly less formation of bone. No inflammation was seen with light microscopy, and only traces of the polyorthoester could be detected in the defects that had been filled with the composite or with polyorthoester alone.

Animals↗
PubMed2004

[Occurrence and survival in children with selected types of congenital defects in the Czech Republic 1994-2001. Part 2].

OBJECTIVE: Analysis of prenatal and postnatal incidence of selected types of birth defects in the Czech Republic in the period of 1994-2001. In the postnatally diagnosed cases the survival in the course of the first year of life was analyzed. Selected birth defects--omphalocele, gastroschisis, abdominal wall defects, renal agenesis and hypoplasie, cystic kidney disease, diaphragm hernia. TYPE OF STUDY: Retrospective analysis from registry of birth defects in the Institute of Health Information and Statistie of the Czech Republic in the period of 1994-2001. METHOD: The authors analyzed frequency of prenatally and postnatally diagnosed cases of 6 selected types of birth defects in the period of 1994-2001 in the Czech Republic. In cases where the diagnosis was established after birth, analysis of survival and death rate during the first year of life was performed for selected birth defects. RESULTS: In the period of 1994-2001, 745,410 children were born in the Czech Republic. There were 22,711 children with one or more birth defects diagnosed in this cohort during the first year of life. The mean incidence of all cases in this period of observation was 304.52 per 10,000 live born children. The percentage of prenatally diagnosed cases, ended for this diagnosis in the above mentioned period of observation, was 66% in abdominal wall defects, 55% in omphalocele and 77% in gastroschisis. In cases where the diagnosis was established after birth, 93.55% of children survived the first year of life. In cases of birth cystic kidney 25% were diagnosed prenatally and ended for renal agenesis and hypoplasie of the kidneys and 27% due to cystic kidney. In cases of diaphragmatic hernia, 31% of cases were diagnosed an ended prematurely after positive prenatal diagnosis, and about one third of affected children died during the first year of life. CONCLUSION: Incidence of these types of birth defects in newborns in the Czech Republic is presently lower than in previous years particularly due to successful prenatal diagnostics. Cases where the diagnosis is established after delivery represent an important part of perinatal, neonatal and post-neonatal mortality and morbility.

Congenital Abnormalities↗
PubMed2004

[Incidence of birth defects in children of mothers using medications in the 1st trimester of pregnancy in the Czech Republic 1996-2002].

OBJECTIVE: To process the results on the incidence of birth defects in the children of mothers using medicines in the first trimester of pregnancy in the Czech Republic during 1996-2002. DESIGN: A retrospective analysis of data from the National Register of birth Defects in the Czech Republic. METHODS: The data from the nationwide register of birth defects administrated in the Institute of Health Information and Statistics of the Czech Republic for the period 1996-2002 were used for the study. The data on the incidences of selected types of birth defects identified in children born to mothers using medicines in the first trimester of pregnancy were compiled and an analysis of these medicines was carried out in relation to the diagnosed types of birth defects. The data on healthy children born to mothers using medicines during the 1st trimester of pregnancy were used as the control sample. RESULTS: In our retrospective analysis covering the years 1996-2002, a total of 1,146 birth defects were identified in children of women using medication in the 1st trimester of pregnancy and a total of 891 children affected in this way were identified. CONCLUSION: The study presents the updated results of these analyses based on nationwide registration of birth defects for a seven-year period. It analyses the types of birth defects in the children of women using medication in the 1st trimester of pregnancy and the types of medicines used by these women. In our study, we have found a significantly higher incidence in the population of the children born to women using medicines in the 1st trimester of pregnancy in several cases. From among the group of cleft defects affecting the central nervous system, this concerns for example anencephalia and spina bifida, as well as congenital hydrocephalus, anophthalmy/microphthalmy, auricle abnormalities and limb reduction deformities. From these results that we produced, it is of course not possible to draw significant conclusions with a clinical impact. However, pregnant women should avoid any medicines in the first trimester of pregnancy, except for those cases, which are strictly indicated from the medical point of view and which are recognised as reasonably safe. As concerns the use of other medicines, their genetic and teratogenic risk should be assessed comprehensively by a specialised clinical geneticist on a case-by-case basis.

Abnormalities, Drug-Induced↗
PubMed2005

[Experimental study on repair of goat tibia defect with marrow stromal cell and bio-derived bone].

OBJECTIVE: To investigate the feasibility of repairing goat tibia defect with marrow stromal cells (MSCs). METHODS: MSCs were cocultured with the bio-derived bone in vitro, and the 20 mm tibia defects were made and fixed with plate in 35 goats, and they were divided into the experimental group, control group and blank group. The defects on the right side were filled with tissue engineering bone as the experimental group, the defects on the left side with bio-derived bone as the control group in 33 goats, and the defect on the both sides were not filled with any materials as the blank group in 2 goats. The repair capability was assessed physically, histopathologically and biomechanically at 2, 4, 6, 8, 12, 16 and 24 weeks after operation in 3 groups. RESULTS: By physical, histopathological and biomechanical examinations, the bio-derived bone was partially absorbed in the experimental group and was rarely absorbed in the control group in the 4th week; the defects were partially repaired in the experimental group, and in the control group, few new bones were observed in the two ends of the implants, in which there was fibrous tissue. The effects of biomechanics had no statistically significant difference between the experimental group and the control group (P>0.05) in the 8th week; the defects were perfectly repaired in the experimental group and the effects of biomechanics had statistically significant difference between two groups (P<0.05) in the 12th weeks. The defects were not repaired in the 24th week in the blank group. CONCLUSION: The tissue engineering bone can efficiently repair bone defect, and its repair capability is better than that of bio-derived bone alone both in quantity and in quality of bone formation.

Animals↗
PubMed2005

[Experimental study on repairing segmental bone defect with bio-derived bone preserved by various methods].

OBJECTIVE: To study the difference of repairing segmental bone defect with bio-derived bone preserved by various methods. METHODS: Freeze-dried biomaterials had been stored in two different preservation solutions for three months, while the biomaterials stored for same period were observed as control group. The experimental model of 15 mm radial segmental defect was made in 60 New Zealand white rabbits, which were divided into groups A, B and C according to transplant materials preserved by various methods. Groups A and B were deeply divided into A1 and A2 subgroups, B1 and B2 subgroups according to whether materials were cocultured with osteoblasts. Tissue engineered bone was used to repair bone defects of left limbs in A1 and B1 subgroups, while simple material to repair defects of right limbs in A2 and B2 subgroups. Group C was divided into C1 and C2 subgroups. Freeze-dried material was used to repair bone defects of the left limbs, while defects of the right limbs as blank control group. The samples were harvested and observed by the roentgenographical, histomorphological, biomechanical and computerized graphical analysis at 4, 8 and 16 weeks. RESULTS: All of the defects treated with implants exhibited new bone formation 4, 8 and 16 weeks postoperatively, increasing with time. The radiological, histomorphological and biomechanical evaluation showed that the ability of new bone formation was arranged in 6 subgroups as follows: A1>A2>C1>B1>B2>C2, the difference was significant between them (P<0.001, P<0.05). The ability of new bone formation was strongest and at 16 weeks the defect was bridged with the appearance of marrow cavities in A1 subgroup, the biomechanical properties in implants approached to those of normal bone. CONCLUSION: The choice of proper preservation solution can improve the ability of repairing bone defect.

Animals↗
PubMed2005

[Birth defects in the Czech Republic--expected incidence in the coming years].

OBJECTIVE: The study was aimed to analyze expected incidence of birth defects as a whole and some selected types of birth defects on the basis of the mean values over the period of 1983-2002 in the Czech Republic. A possible incidence of birth defects in the Czech Republic in the coming years was evaluated. DESIGN: A statistical estimate and analysis of the expected incidence based on retrospective values of incidence of birth defects from the data of the Institute of the Care of Mother and Child (UPMD) and the Institute of Medical Information and Statistics of the Czech Republic (UZIS). METHODS: The estimate of incidence of birth defects as a whole as well as according to individual selected types with the application of exponential adjustment of time series with the time-weighted parameter for individual years of the retrospective period of time. RESULTS AND CONCLUSIONS: The statistical estimate indicates that 1,244,767 children should be born in the Czech Republic over the period of 2003-2015. In this period of time there should be 50,706-67,628 prenatally and postnatally diagnosed cases of birth defects in this republic. These our results represent an estimate of birth defects in the Czech Republic in the coming years and draw attention to the importance of registry of birth defects in the Czech Republic. The epidemiology of birth defects actually represents a multidisciplinary branch, which is primarily aimed at and providing data for the evaluation of quality of prenatal and postnatal care in the Czech Republic.

Congenital Abnormalities↗
PubMed2006

Evaluation of speech in patients with partial surgically acquired defects: pre and post prosthetic obturation.

AIM: Maxillectomy often results in a high level of morbidity with significant psychological and functional implications for the patient. Such disabilities include inability to masticate, deglutition, and speech disturbance. Unfortunately, little is known about the nature of the speech disturbance and the influence of the class of surgical defects in this group of patients. The aims of the present study were to assess the effectiveness of the maxillary obturator as a speech rehabilitation aid and to examine the influence of the classes of surgical defects on speech intelligibility (SI). MATERIALS AND METHODS: Twelve patients aged between 18 and 60 years with surgically acquired partial maxillary defects were included in this study. The patients were given immediate surgical obturators six to ten days after surgery, which were then converted to interim obturators by relining with tissue conditioner. Interim prostheses were used for two to three months until healing and resorption were found satisfactory after which the definitive obturators were fabricated. The SI test described by Plank et al. and Wheeler et al. was employed in this study. There were significant improvements in the mean SI score from 59.8% without prosthetic obturation, to 89.2% following interim obturation, and 94.7% following definitive obturation (p<0.005). Nine patients (75%) had class I surgical defects, two patients (16.67%) had class II defects, while only one patient (8.33%) had a class VI surgical defect. None of the patients had class III, IV, or class V surgical defects. There was an improvement in the SI score from class I to class VI without obturation, after insertion of interim obturator, and after insertion of the definitive obturator. CONCLUSION: Results support the widely held view that the maxillary obturator is a useful speech rehabilitation aid. It also shows immediate, interim, and definitive obturators are all important in the speech rehabilitation of patients with surgically acquired maxillary defects. Moreover SI is affected by the class of defect.

Adolescent↗
PubMed2006

[Repair of compound skin and bone defects in hands with pedicle osteocutaneous groin flap based on superficial circumflex iliac vessels].

OBJECTIVE: To investigate the outcome of repairing hand composite defects using pedicle osteocutaneous groin flap. METHODS: From February 1998 to May 2004, 33 cases of hand composite defects were repaired with pedicle osteocutaneous groin flap. There were 22 males and 11 females. The age was 19 to 54 years with an average of 24.3 years. The defect was caused by palmar penetrating injury in 17 cases, by dorsal hand crushing injury in 9 cases and by other injury in 7 cases. Twenty-three cases complicated by metacarpal defect, 10 by phalanx defect. The size of skin defect was 3. 5 cm X 2.0 cm to 15.0 cm X 10.0 cm, the size of bone defect was 1.5 to 3.5 cm. After 3 to 7 days of primary debridement, defect was repaired by the pedicle osteocutaneous groin flap based on the superficial circumflex iliac vessels. The flap size was 4.0 cm X 2.5 cm to 17.0 cm X 11.0 cm. RESULTS: All the osteocutaneous flaps survived. During the 4 to 22 months follow-up postoperatively, the texture, appearance and function of the flap were excellent and bone union was obtained in all cases after 7 to 9 weeks of operation. CONCLUSION: The pedicle osteocutaneous groin flap is an ideal flap to repair the composite defect of the hand, with the benefit of simple procedure and reliable blood supply.

Adult↗
PubMed2006

Effect of synthetic cell-binding peptide on the healing of cortical segmental bone defects.

OBJECTIVE: To determine the effect of inorganic bone matric/Pepgen P-15 (ABM/P-15) on the healing of a critical sized segmental defect in a rat radius using a radiological and histological grading system. METHODS: We carried out this study at the Research Laboratories, Gazi University School of Medicine in 2004. Critical sized segmental defects were created in the radius of 36 Wistar rats. Thirteen defects were filled with ABM/P-15 Flow (gel form), 12 defects were filled with ABM/P-15, and 11 defects were used as a control group. The rats were sacrificed at the tenth week, and healing of the defects was evaluated radiographically and histologically. RESULTS: The usage of ABM/P-15 and ABM/P-15 Flow were demonstrated to improve healing of segmental bone defects compared with the control group. Statistical evaluation showed that there were significant differences between control sites, and the sites treated with P-15 and P-15 Flow (p=0.011). The highest radiological and histological grades were achieved by P-15. CONCLUSION: Segmental cortical bone defects may be treated with ABM/P-15 instead of bone allografts, and autografts. According to the radiological and histological parameters measured in this study, the implantation of ABM/P-15 resulted in optimum healing of the segmental cortical bone defects. Pepgen P-15 has a positive effect on bone healing, without any immunogenic features and disease transmission risk. Therefore, ABM/P-15 can also be used for orthopedic surgery.

Animals↗
PubMed2006

[Reconstruction of orbital floor defect with polylacticglycolide acid/recombinant human bone morphogenetic protein 2 compound implanted material in sheep].

OBJECTIVE: To study the effect and safety of polylacticglycolide acid copolymer (PLGA) and recombinant human bone morphogenetic protein 2 (rhBMP-2) as implanted biomaterials for reconstruction orbital floor defects in sheep and find the relationship between implant materials degradation and orbital floor defects restoration. METHODS: Nine sheep (eighteen eyes) with orbital floor defect were divided into three groups randomly. Group A was the control without treatment. Group B was treated with PLGA and group C was received PLGA/rhBMP-2. Cosmetic appearances and complications were observed after surgery. CT scan, 3D reconstruction, defect area measurement and histological examination were performed on a week, three months and six months after operation. RESULTS: No complication was observed. The CT examinations showed that orbital floor defect in group C was almost disappeared by six months, however in group A and group B only partially orbital floor defect was repaired. Histological examinations showed that all materials were absorbed on six months. The orbit defects in group A were replaced by fiber tissue. The defect areas in group B were consisted of bone tissue in the peripheral and fiber tissue in the center. In group C the reconstructed areas were replaced by bone tissue, loose connective tissue and mucosal epithelia layers. CONCLUSION: The thick of 0.5 mm PLGA/rhBMP-2 sheet is a good substitute material of bone graft and may be used for orbital fracture defect reconstruction in clinic in the future.

Absorbable Implants↗
PubMed2006

[Repairing widespread traumatic soft tissue defects in lower limb with free latissimus dorsi muscle-skin flaps].

OBJECTIVE: To explore the results of repairing widespread traumatic soft tissue defects in the heels and adjacent regions with free latissimus dorsi muscle-skin flaps. METHODS: From March 1998 to May 2005, 10 cases of widespread traumatic soft tissue defects in the heels and adjacent regions were repaired with free latissimus dorsi muscle-skin flaps; Of the 10 patients, 9 were male and 1 was female, whose ages ranged from 32 to 60 years, and the disease course was 2 hours to 2 months. The defect was by plough-machine injury in 5 cases, by crush injury in 2 cases, by snake injury in 2 cases, and electricity injury in 1 case. Eight cases of defects involved in the posterior of heel and leg, the defect area ranged from 21 cm x 12 cm to 35 cm x 15 cm; 2 cases had widespread soft tissue defects on heel, ankle, sole and dorsal foot, and the defect area was 27 cmX 14 cm and 30 cm x 21 cm respectively. All cases were accompanied by the exposure of bone; 6 cases by fracture; 4 cases by open infection of ankle joint; and 2 cases by injuries of the posterior tibial vessel and the tibial nerve. The sizes of the dissected flap ranged from 25 cm x 14 cm to 33 cm x 24 cm. The donor sites were covered by large mid-thickness flap. RESULTS: There were no postoperative complication of vascular crisis and infection. Ten flaps survived completely and the wounds healed by first intention. After a follow-up of 3 to 24 months, five cases received two-stage plastic operation because bulky flaps bring some trouble in wearing shoes. In 5 cases of reconstructed sensation, two cases recovered pain and temperature sensation. All cases recovered the abilities to stand and walk without ulcer complication. CONCLUSION: The free latissimus dorsi muscle-skin flap is an ideal flap for repairing widespread traumatic soft tissue defects and infectious wounds with muscle defects and bone exposure in the heel and adjacent regions, because it has such advantages as adequate blood supply, big dermatomic area, and excellent ability to resist infection.

Adult↗
PubMed2006

[Repair of extensive gluteal-sacral defect with posterior femoral cutaneous neurovascular island flap].

OBJECTIVE: To explore the clinical value of repairing extensive gluteal-sacral defects with the posterior femoral cutaneous neurovascular island flap. METHODS: From July 2002 to May 2005, the posterior femoral cutaneous neurovascular flap was applied to repairing extensive gluteal-sacral defects in 6 patients (3 males, 3 females; aged 31-59 years). Three patients had a skin defect in the gluteal-sacral region caused by squamous cell carcinoma, 1 patient had the defect in the same region caused by malignant fibrohistiocytoma, and 2 patients had the defect caused by bedsores of grade III . The area of defects ranged from 15 cm X 8 cm to 16 cm X 10 cm. The flaps ranged in area from 15 cm x 8 cm to 18 cm x 10 cm. RESULTS: In all the 6 patients had their flaps survived well and the wounds gained the primary healing. The follow-up for 2. 5-12 months revealed that, flaps were satisfactory in their appearance, texture, and sensory functions. CONCLUSION: The repair of extensive gluteal-sacral defects with the posterior femoral cutaneous neurovascular island flap has advantages of the unchanged anatomic structures, reliable blood supply, easy dissection for extensive defects, good sensory recovery, and sacrificing no major vessels; therefore, this kind of repair is an optimal approach to repairing extensive gluteal-sacral defects.

Adult↗
PubMed1988

Defective thymic education of L3T4+ T helper cell function in graft-vs-host mice.

Our study investigates the effect of a prior graft-vs-host (GVH) reaction on the subsequent ability of irradiated, bone marrow-re-populated mice to develop T cell function. The results indicate that such GVH-bone marrow transplanted (BMT) mice do not generate CTL responses to trinitrophenyl-modified syngeneic cells (TNP-self), but do generate strong CTL activity to H-2 alloantigens. This selective deficiency in TNP-self CTL response potential appeared as early as 10 days after GVH, and required both L3T4+ and Lyt-2+ donor T cells. The in vitro addition of either soluble Th factors or L3T4-enriched spleen cells from normal mice circumvented the defect in the TNP-self response in GVH-BMT mice. These results indicate that T effector function was not defective, and instead suggest a Th defect. Cell depletion and antibody-blocking, as well as IL-2 production experiments, indicate that the Th defect was selective for L3T4+ Th population and not for Lyt-2+ Th population. This defect in L3T4 Th function is not accounted for by the approximate twofold reduction in L3T4 cell numbers in GVH-BMT mice, because IL-2 production and CTL generation to L3T4-dependent Ag were at least eightfold below control levels. Rather, defective L3T4 Th function appears to be the consequence of a GVH-induced defect in thymic maturation because the defect was corrected in vivo by a neonatal parental thymus graft before irradiation and bone marrow transplantation. This system may be useful for elucidating the role of the thymus in the maturation of Th cells. Our findings raise the possibility that impaired development of T cell function occurring in marrow grafted patients who have undergone a GVH reaction could be partly due to a GVH-induced thymic defect.

Animals↗