The Applied And Basal Research About Temporary Ectopic Implantation Of Amputated Limb

Objective (1) To study the applicable object and methods of "Temporary Ectopic Implantation of Amputated Limb", to search the suitable recipient site and the ideal method of implantation in the second stage. (2) To get the systemic theory and technique of "Temporary Ectopic Implantation of Amputated Limb",to provide the skill supports to lift the rate of success for application.(3) To study the methods of reinnervation after ectopic transplantation of skeletal muscle of amputated limbs, to provide the theory support of such kainds of researchs in future.Methods (1) The study of reinnervation after ectopic transplantation of skeletal muscle of amputated limbs.①60 Sprague-Dewley male rats which were 8 months old were randomly divided into 3 groups: Experimental Control group, Original Implantation group, and Ectopic transplantation group. Experimental Control group: cut off obturator nerve which controlled right gracilis. Original Implantation group: cut off the right gracilis, replanted it to its original site and implanted the obturator nerve to the muscle. Ectopic transplantation group: cut off the right gracilis, transplanted the muscle to the left leg and implanted the obturator nerve to the muscle. After 25 weeks, colleted the neurophysiological information through Electromyography and measured the weight of the muscle.②90 Sprague-Dewley male rats which were 8 months old were randomly divided into 3 groups: Experimental Control group, motor reinnervation group, sensory reinnervation group. Cut off the right gracilis, transplanted the muscle to the left leg , Experimental Control group: no reinnervation was performed onthe obturator nerve, sensory reinnervation group: obturator nerve was coapted with recipient saphenous nerve, motor reinnervation group: obturator nerve was coapted with femoral nerve motor branch. After 25 weeks, measured the weight of the muscle, histological examination. (2) Correlative researches of applying anatomy,image and tissue about "Temporary Ectopic Implantation of Amputated Limb".①30 specimens of Chinese adult (half of them are men's specimen,half of them are women's specimen),30 Chinese adults who are volunteers randomly (half of them are men,half of them are women). Dessect the vessels, measure the external perimeter, thickness and inner perimeter of the vessels, measure the inner perimeter of the vessels on alive body with supersonic image,contrast the inner perimeter between alive body and specimen.②Select 30 rabbits randomly,cut off the middle of right posterior limb to make amputated model, after 3 weeks,observe the vessel's morphological and tissue change of approximate end of extremity. (3)The applying research of "Temporary Eetopic Implantation of Amputated Limb" . Performe 11 cases of temporary ectopic implantation of amputated limbs. All of amputations were identified with combined extensive segmental injuries in the proximal site of amputations and closed head injury, abdominal and thoracic injuries, and serious blood loss. The amputated parts were implanted onto the contra-lateral healthy extremities and survived. The implanted parts were then harvested and replanted onto theanatomic positions and follow up.Results (1) The study of reinnervation after ectopic transplantation of skeletal muscle of amputated limbs.①The potential without control of the nerve existed in experimental control group, no dominant differences about latency , amplitude and conduct velocity existed between original implantation group and ectopic transplantation group(P > 0.05).The atrophy of gracilis was dominant in experimental control group, the weight of the muscle was 158.0±19.3 mg. The weight of the muscle was 509.6±14.5mg in ectopic transplantation group, 516.8±12.7mg in original implantation group, no dominant difference existed in two groups(P > 0.05). The weight of the muscle in original implantation and ectopic transplantation group was larger than the weight in experimental control group(P < 0.05).②The atrophy of gracilis was dominant in experimental control group, the weight of the muscle was 204.0±15.3 mg. The weight of the muscle was 394.8±12.9mg in motor reinnervation group, 389.2±13.5mg in sensory reinnervation group, no dominant difference existed in two groups(P > 0.05). The weight of the muscle in both motor reinnervation group and sensory reinnervation group were larger than the weight in experimental control group(P < 0.05).The evidences of reinnervation were found in histological examination. (2) Correlative researches of applying anatomy,image and tissue about "Temporary Eetopic Implantation of Amputated Limb".①There are double blood supply systems in human's forearm and leg.The site of vessels in forearm and leg are invariablen, superficial and easy to be found. The caliber of the vessel is thick.No dominant difference is found between left and right limb about the external perimeter,thickness and inner perimeter of the vessels. No dominant difference is found between alive body and specimen about inner perimeter of the vessels.②The artery of approximate end of extremity become thin and the middle layer of smooth muscle become atrophy.The average diameter of the artery is 50% of the normal artery. The inner elastic layer is asymmetry.(3) The applying research of "Temporary Eetopic Implantation of Amputated Limb". All of implantation and staged replantation survived. After following-up, all of staged replanted parts restored protective sensation, and partial motor function was recovered in some cases. Conclusion (1) "Temporary ectopic implantation of the amputated limbs" provides an alternative for the salvage of amputated extremities under these special circumstances. It can save the limb's integrity and function, relieve the rate of deformity.(2)Devastating segmental injuries of the proximal extremities, and the conditions of the amputation wounds, combined severe complex injuries and the traumatic shock are also indicated for temporary ectopic implantation of the amputated part, since the patient with critical condition can not tolerate a long procedure of replantation. Above mentions are the applying indications of "Temporary ectopic implantation of the amputated limbs".(3) Contra-lateral healthy extremity is an ideal recipient site for temporary ectopic implantation, from which cross-arm or cross leg flap can be designed to protect the blood supply to the second staged replantation and improve the replantation. (4)Motor nerve implantation, motor or sensory nerve anastomosis after ectopic transplantation of skeletal muscle could prevent the atrophy of the muscle and resume partial function of nerve.