Clinical observation on wound measurement grid and perforator flap design / 中华显微外科杂志

Objective:To investigate the application of self-designed wound measuring grid in the measurement of wound and the design of perforator flap.Methods:From February 2018 to February 2020, 31 cases of soft tissue defects of limbs were repaired by free transfer of perforator flap. During the operation, the self-designed membrane with measurement grid was used to measure the wound surface. The flaps were designed and harvested according to the accurate measurement of the wound. The flaps were reviewed at hospital clinic during follow-up.Results:All patients entered 3-15 months of follow-up with an average of 8 months. All 31 flaps survived, of which 2 flaps encountered vascular crisis and were rescued after surgical exploration. There was no infection of flaps and all flaps had stage I healing. The flaps were satisfactory in appearance with the sensation recovery to S 2 in 21 cases and S 3 in 10 cases. Only linear scars were left on the donor sites. Conclusion:The membrane with a measurement grid can accurately measure a wound, and help the design of the flap according to the measured size and profile of the wound. It can reduce the operation time and the risk as well as to improve the operation efficiency. The clinical application is satisfactory. Large scale and multi-centre studies are required to further prove the benefit of the measurement grid.

Repairing thumb tip defect with radial thenar fasciocutaneous flap / 中华显微外科杂志

Objective:To investigate the surgical method and clinical effect in the repair of thumb tip defect with radial thenar fasciocutaneous flap.Methods:From March, 2016 to January, 2019, 15 patients with thumb tip defect were treated by radial thenar fasciocutaneous flap. There were 6 defects in left thumb and 9 in right thumb. All the thumbtip defects had the exposure of digital bone, and some had defects of digital bone itself. The size of defects ranged from 1.0 cm×2.0 cm to 1.5 cm×3.0 cm, and the size of the flaps ranged from 1.2 cm×2.5 cm to 1.8 cm×4.0 cm. All of the donor sites were directly closed. The patients entered follow-up by outpatient visit, telephone calls or WeChat reviews to evaluate the quality of the flaps and the clinical effects of the surgery.Results:All flaps survived with good quality. All the donor sites achieved primary healing. The follow-ups lasted for 6 to 18 months with an average of 10.5 months. At the final follow-up review, the appearance of flaps was satisfactory in natural colour, flexible and wear-resistant. There were various degrees of sensation recovery of the flaps, with TPD from 6 mm to 12 mm. The sensation around the donor site was close to normal. Function of the thumbs was evaluated according to the total active movement (TAM) evaluation system. Twelve thumbs were graded excellent and 3 in good.Conclusion:The radial thenar fasciocutaneous flap achieved satisfactory clinical effect in the repair of thumb tip defect. The texture of the flaps is close to the recipient site and the damage to the donor site is minimal.

Repairing the defect of fingernail bed by the second toenail flap with the dorsal bone of the phalange / 中华显微外科杂志

Objective:To explore the clinical effect of the second toenail flap with the dorsal bone of the phalange in repairing the defect of fingernail bed.Methods:From January, 2012 to June, 2019, 10 patients with large area of fingernail bed defect were treated by the second toenail flap with bone on the back of the phalanx. The survival of the flap was observed after the operation, and the fracture healing, the shape of the nail and the flexion and extension function of the finger joint were observed in the outpatient follow-up.Results:All flaps of the second toenail survived. The average follow-up period was 8 (4-12) months. The fractured ends of 10 patients' phalanges healed well without nonunion, good appearance of toenail and deformity of toenail. The recovery of hand function was evaluated according to the evaluation standard of upper limb function of Hand Surgery Society of Chinese Medical Association, 9 cases were excellent, and 1 case was good.Conclusion:The second toenail flap with dorsal bone of the phalanx preserved is easy to cut, simple to operate, and has good clinical effect. It is a good method to repair the defect of the fingernail bed.

The free flap from the superficial palmar branch of radial artery innervated by the lateral cutaneous nerve of the forearm repair the defects of finger pulp / 中华显微外科杂志

Objective To explore the outcomes of free flap from the radial artery superficial palmar branch (RASP) innervated by the lateral cutaneous nerve of the forearm for repairing the defects of finger pulp. Methods From April, 2013 to February, 2015, 20 fingers in 20 cases were treated with free flap from RASP innervated by the lateral cutaneous nerve of the forearm. The area of flap was from 1.8 cm×2.0 cm to 2.0 cm×4.0 cm. Postoperative fol-low up was done termly. Results All 20 flaps survived. All cases were followed-up for 7-20 months ( averag, 12 months). The flaps appeared well with good texture. The two-point discrimination was from 7 mm to 12 mm, and grad-ed with S3 and S3+sensation. There was little scar noted at the donor site in the wrist. There was no influence of hand and wrist function. Conclusion The method of using free flap from SASP innervated by the lateral cutaneous nerve of the forearm to repair the defects of finger pulp has good clinical effect.

Comparison of two lung protective ventilation modes in severe traumatic wet lung with lung ventilation strategy / 中国医师进修杂志

Objective To compare the clinical effective of two lung protective ventilation modes in severe traumatic wet lung (STWL) with lung ventilation strategy.Methods Ninety-two cases of STWL patients were divided into adaptive support ventilation (ASV) group and pressure type synchronous intermittent aeration instruction (P-SIMV) + pressure support ventilation (PSV) group with 46 cases by random number table method in each.Heart rate,mean arterial pressure (MAP),pH value,arterial blood oxygen partial pressure (PaO2),arterial bold carbondioxide partial pressure (PaCO2),minute ventilation,tidal volume,total respiratory frequency,airway peak pressure and mean airway pressure,airway closure pressure,and pulmonary compliance at 30 min after mechanical ventilation were compared between two groups.Results At 30 min after mechanical ventilation,heart rate,MAP,pH value,PaO2,PaCO2 and mean airway pressure,airway peak pressure and airway closure pressure between two groups had no statistical significance (P ＞0.05).But tidal volume,minute ventilation,total respiratory frequency,pulmonary compliance in ASV group were obviously improved compared with those in P-SIMV + PSV group [(692.6 ± 38.6) mlvs.(558.5±25.6)ml,(8.9± 1.7) Lvs.(7.8± 1.6) L,(16.3±3.3) times/min vs.(21.3±3.2)times/min,(42.15 ± 5.28) ml/cmH2O (1 cmH2O =0.098 kPa) vs.(39.15±5.47) ml/cmH2O] (P ＜ 0.01 or ＜0.05).Conclusion For patients with STWL in the lung protective ventilation strategy,ASV can automatically adjust the level of inspiratory pressure support according to the respiratory mechanics condition of the patients,improving tidal volume and pulmonary compliance,and reducing respiratory rate,which has no obvious effect on the hemodynamics and vital signs.