Minimally Invasive Treatment For Hemangioma And Vascular Malformation Applying High-frequency Bipolar Electrocoagulation By Fine Needles And The Clinic Research Of Refined Scrotal-septal Fasciocutaneous Flap

Part I:Minimally invasive treatment for hemangioma and vascular malformation applying high-frequency bipolar electrocoagulation by fine needles: a preliminary studyBackgroundSuperficial hemangioma and vascular malformation are common anomalies affecting one’s appearance and function. Most cases need early intervening treatment. High-frequency bipolar electrocoagulation by fine needles is a minimally invasive method in treating hemangioma and vascular malformation. The fine needles puncture into the subcutaneous tissue, with an insulating protective sleeve, target and destroy the lesion tissue. The therapeutic or experimental parameters contain power, time and the needle length. In the publications, we have only find the research of power, and none have mentioned about other parameters such as time and needle length. Thus, we designed the experiment to detect the optimal parameters for individual choice. However, the existing animal models for hemangioma is not huge enough for the experiment mentioned in this article, and the vascular malformation animal models are not stable enough for spontaneously thrombosis established in the vascular anastomosis. Since we choose porcine liver to simulate hemangioma, the rabbit vein and its surrounding tissue to simulate venous malformation, the cockscomb and chicken wattle to simulate capillary malformation. The above four different tissues are designed to be damaged by high-frequency bipolar electrocoagulation by fine needles by different experimental parameters. According to analyze the relationship between the experimental parameters and tissue damage area, we hope to determine the optimal parameters and provide a reference for clinic application of minimally invasive treatment for hemangioma and vascular malformation applying high-frequency bipolar electrocoagulation by fine needles.The experimental research of different tissues applying high-frequency bipolar electrocoagulation by fine needlesPurposeAccording to measure the maximum damage diameter of the four tissues, and the content of VEGF of two tissues being damaged by different parameters, we analyzing the relationship between the experimental parameters and tissue damage area. We hope to determine the optimal parameters and provide a reference for clinic application of minimally invasive treatment for hemangioma and vascular malformation applying high-frequency bipolar electrocoagulation by fine needles.MethodsChoosing porcine liver to simulate hemangioma, the rabbit vein and its surrounding tissue to simulate venous malformation, the cockscomb and chicken wattle to simulate capillary malformation. Analyzing the experimental results and parameters from macroscopic and microscopic perspective, including the tissue damage diameter, the patency of subcutaneous vein, and the content of VEGF.Results① The three experimental parameters including power, time and needle length have a significant impact on the result of tissue damage area, wherein the power is positively related to the results.② According to the porcine liver experiment, the three optimal parameters are 6-15W,3mm/5mm,2-3S,9-15W,7mm/9mm,2-3S respectively.③ According to the rabbit vein and its surrounding subcutaneous tissue experiment, the three optimal parameters are 6-9W,3mm/5mm,2S,6-9W,7mm,2-3S respectively.④According to the cockscomb experiment, the three optimal parameters are 6-9W, 5mm,2S,6-9W,7mm,2-3S respectively.ConclusionDuring the application of high-frequency bipolar electrocoagulation by fine needles to injury different tissues, three of the experimental parameters have significant impact on the result. In order to get the optimal tissue damage result, we have to choose the optimal experimental parameters.The clinic research of minimally invasive treatment for hemangioma and vascular malformation applying high-frequency bipolar electrocoagulation by fine needlesPurposeIntroduce a minimally invasive treatment for hemangioma and vascular malformation, then evaluate and synthesize its practical and clinical effect.MethodsWe have applied the minimally invasive treatment for 8 cases of hemangioma and vascular malformation from October 2013 to August 2015. The therapeutic power designed to be 6-15W, time was 2-3S, and the needle length was designed according to the size and location of the lesion by 3-5mm.ResultsZero case was cured,2 cases worked well,3 cases effective,2 cases ineffective, and 1 was lost, thus the therapeutically effective rate was 62.5%. There was no bleeding, infection, skin irritation, ulceration, no scarring after the surgery.ConclusionMinimally invasive treatment for hemangioma and vascular malformation applying high-frequency bipolar electrocoagulation by fine needles is a selective treatment with fewer complications. It holds certain advantages for patients have limitation lesions in subcutaneous tissue of special place, and those who were in developmental stages. However, it would get a poor result for patients with high-flow vascular malformation, and widely distributed lesions.Part II:The clinic research of refined scrotal-septal fasciocutaneous flapPurposeIntroduce the refined scrotal-septal fasciocutaneous flap used in hypospadias repair surgeries, then evaluate and synthesize its practical and clinical effect.MethodsWe have applied the refined scrotal-septal fasciocutaneous flap in patients with hypospadias or urethral fistula from October 2013 to August 2015. Two cases applying cicada-like flap-skin grafts to reconstruct the neourethra. Twelve cases applying the scrotal-septal fasciocutaneous flap as a multiple coverage, in which 4 cases were used for urethral fistula repair and 8 cases used as a coverage above the neouretha.Results① The two case used the flap for reconstructing the neourethra appeared slightly glans bend and penile-scrotal adhesion, with no discomfort, no urinary fistula, urethral stricture, urinary not disperse, no chordee, glans urethral orifice is located in a vertical slit-like top.② The 8 cases used the flap as a coverage showed that 2 cases revealed infection and 1 got urethral fistula eventually. Three cases appeared slightly glans bend,5 cases appeared hair growth in the ventral side of the penis,4 cases appeared slightly penile-scrotal adhesion. In addition there was no urinary fistula, infection, bleeding, no penile torsion, no chordee, and all flaps survived well.③ The 4 cases used the flap to repair the urethral fistula appeared no bleeding, no infection, no urethral fistula, no dysuresia, and all flaps survived well.ConclusionThe refined scrotal-septal fasciocutaneous flap, including sufficient fascia tissue and reliable blood supply, is a good choice for hypospadias repair surgeries. It could solve the problem of tissue shortage. After all, the long-term effect of applying the flap in reconstructing neourethral requires further observation.