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Objective@#To evaluate one-stage repair of leg open fracture with soft tissue defect by fixation plus skin flap.@*Methods@#From January 2011 to January 2018, 34 patients with leg open fracture plus soft tissue defect were treated at Department of Orthopedics, The Second Affiliated Hospital to Harbin Medical University. They were 31 males and 3 females, aged from 13 to 54 years(average, 35 years). According to the Gustilo classification, the defects were type ⅢA in 31 cases and type ⅢB in 3 cases. The wound size ranged from 6 cm×3 cm to 25 cm×10 cm. All patients were treated with emergency fracture fixation and flap repair by one stage after thorough debridement. Internal bone plating was performed in 32 patients and external fixation at a single arm in 2 patients. All defects were repaired with a free anterolateral thigh flap. Flap survival, vascular crisis and bone infection were followed up postoperatively.@*Results@#All the free flaps survived in the 34 cases with no vascular crisis. These patients were followed up for 6 months to 3 years (average, 10 years). The flaps healed well, with good appearance and soft texture. No bone infection occurred at the defective sites. After postoperative rehabilitation, the knee extension ranged from 160° to 180°, knee flexion from 90° to 110°, ankle dorsal extension from 90° to 110°, and ankle plantar flexion from 100° to 120°.@*Conclusion@#Soft tissue defects in leg open fracture can be effectively treated by flap repair after thorough debridement at the same time of fracture fixation, because the primary wound healing can avoid infection and lead to fine survival of the flap.
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Objective To evaluate one-stage repair of leg open fracture with soft tissue defect by fixation plus skin flap.Methods From January 2011 to January 2018,34 patients with leg open fracture plus soft tissue defect were treated at Department of Orthopedics,The Second Affiliated Hospital to Harbin Medical University.They were 31 males and 3 females,aged from 13 to 54 years(average,35 years).According to the Gustilo classification,the defects were type ⅢA in 31 cases and type Ⅲ B in 3 cases.The wound size ranged from 6 cm × 3 cm to 25 cm × 10 cm.All patients were treated with emergency fracture fixation and flap repair by one stage after thorough debridement.Internal bone plating was performed in 32 patients and external fixation at a single arm in 2 patients.All defects were repaired with a free anterolateral thigh flap.Flap survival,vascular crisis and bone infection were followed up postoperatively.Results All the free flaps survived in the 34 cases with no vascular crisis.These patients were followed up for 6 months to 3 years (average,10 years).The flaps healed well,with good appearance and soft texture.No bone infection occurred at the defective sites.After postoperative rehabilitation,the knee extension ranged from 160° to 180°,knee flexion from 90° to 110°,ankle dorsal extension from 90° to 110°,and ankle plantar flexion from 100° to 120°.Conclusion Soft tissue defects in leg open fracture can be effectively treated by flap repair after thorough debridement at the same time of fracture fixation,because the primary wound healing can avoid infection and lead to fine survival of the flap.
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ObjectiveTo explore the practicability of combined surgical treatment for the patients with Hepatocellular Carcinoma(HCC) complicated with Portal Hypertension(PH).MethodsThe clinical data of 43 patients withHCCcomplicatedwithsignificantesophagealvaricesandhyperspleniawereanalyzed retrospectively.All patients were diagnosed with esophageal varices and hypersplenia of different degrees, 14 of them had severe esophageal varices, the other 29 patients had moderate esophageal varices.Firstly all patients underwent splenectomy, 18 of them had selective portoazygous devascularization in addition.After that the patients received hepatectomys ,with local excision or segmentectomy as the major operation methods.Results All patients received hepatectomy combined with splenectomy treatment.There was no perioperative mortality, but 12 patients had complications after the surgery.Over seventy percents patients(33/43)accepted regular followup.Among these 33 patients,the 1-year and 3-year survival rates were 90.9％ (30/33) and 63.6％ (21/33)respectively.Eleven patients died of tumor recurrence.Four patients had upper postoperatively gastrointestinal hemorrhage.ConclusionHepatectomy combined with splenectomy didn't increase the mortality in the patients with HCC complicated with PH.The combined surgery might reduce the incidence of severe complications, such as postoperative bleeding.We believe the combined surgical treatment is feasible for this group of the patients.
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BACKGROUND: Following peripheral nerve transplantation, the time phases and law of growth associated protein 43 (GAP-43) expression in sensory neuron soma of the corresponding dorsal root ganglia remain unclear.OBJECTIVE: To investigate the expression of GAP-43 at the corresponding dorsal root ganglia following sciatic nerve transplantation in rats.METHODS: Adult male Wistar rats were randomly divided into 2 groups: control group (sham-operated group) and experimental group (nerve transplantation group). The rats were killed at 3 days, 1, 2, 4, 6, and 8 weeks after operation and the dorsal root ganglia U-s of every rat was taken for observation. The expression of GAP-43 mRNA and protein in the corresponding segments of spinal cord were detected by RT-PCR and Western-blot techniques.RESULTS AND CONCLUSION: GAP-43 mRNA showed a low level of expression in the control group, which had no obvious changes in different phases. In the experimental group, GAP-43 mRNA expression was observed remarkably in the dorsal root ganglia at the first week, reached a peak at the second week and gradually descended from the sixth week. The GAP-43 protein expression showed the same laws as that of GAP-43 mRNA. The results demonstrated that there exists damage reactivity change in the regeneration ability of neurons.
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Objective To explore the expression of DKK-1 and its clinical value in patients with e-sophageal cancer. Methods The levels of serum DKK-1 were measured by sandwich enzyme linked immu-nosorbent assay(ELISA) in 80 patients with esophageal squamous cell cancer and in 35 healthy subjects. The sensitivities of serum DKK-1, CEA and CYFRA21-1 in the patients with esophageal squamous cell cancer were calculated and analyzed to compare their values in diagnosis of esophageal cancer. Results The serum DKK- 1 levels in patients with esophageal squamous cell cancer were significantly higher than those of healthy subjects(P<0.05). According to the highest value of medicine reference of DKK- 1 (14. 54 ng/ml), its sensitivity and specificity were 66. 25% and 82. 86% respectively; There was a significant difference between the sensitivity of DKK-1 in patients with esophageal squamons cell cancer(66. 25%) and that in healthy subjects(17.14%) (P<0.05). The sensitivitis of serum DKK- 1 in patients with esophageal squamous cell cancer were associated with tumor size, TNM stage and lymph node metastasis(P <0.05),but not associated with gender,age and differentiation grade(P>0.05). And the sensitivity of DKK-1 (66. 25%) was significantly higher than that of CEA, CYFRA21-1 (39. 44% ,25. 35%, P <0. 01). Conclusion DKK-1 played a very important role in the growth and metastasis of esophageal cancer and may be a new tumor marker or an important index in the diagno-sis of esophageal cancer.
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<p><b>BACKGROUND</b>Neoadjuvant chemotheropy can improve the survival rate of patients with stage III non-small cell lung cancer (NSCLC), whose chemotherapy is valid. The value of P53 expression in stage III NSCLC has not been reported. This study is to investigate the value of P53 expression on neoadjuvant chemotherapy sensitivity and prognosis in stage III NSCLC and to investigate the relationship between P53 expression and the result from thoracic CT examination.</p><p><b>METHODS</b>By immunohistochemical technique, the expression of P53 in 51 patients with stage III NSCLC who received neoadjuvant chemotherapy was determined in contrast with 49 patients with stage III NSCLC without neoadjuvant chemotherapy. Every patient who received neoadjuvant chemotherapy was examined by thoracic CT before and after neoadjuvant chemotherapy.</p><p><b>RESULTS</b>(1) There was no significant difference in the positive rate of P53 and the median survival time between neoadjuvant group and control group (48.98% vs 49.02% and 18 months vs 19 months). In neoadjuvant chemotherapy group, the median survival time was significantly different between P53 positive patients and P53 negative ones (13 months vs 31 months). (2) The expression of P53 was related to the neoadjuvant chemotherapeutic response by the results from thoracic CT examination (r=0.537, P < 0.01).</p><p><b>CONCLUSIONS</b>(1)Detection of P53 expression might be helpful to predict the effect of neoadjuvant chemotherapy. (2)The expression of P53 and the neoadjuvant chemotherapeutic results from thoracic CT examination are correlated.</p>